COLUMBIA LIBRARIES OFFSITE HEALTH SCIENCES STANDARD HX64118436 RC201 .C542 1 921 The control of sex i ColuntWa ®ntt)er^itp College of ^f^v^itian^ anb ^urgeong THE CONTROL OF SEX INFECTIONS THE MACMILLAN COMPANY NEW YORK BOSTON • CHICAGO • DALLAS ATLANTA • SAN FRANCISCO MACMILLAN & CO., Limited LONDON • BOMBAY • CALCUTTA MELBOURNE THE MACMILLAN CO. OF CANADA, Ltd. TORONTO THE CONTROL,/^ ^^ OF SEX INFECTIONS BY J. BAYARD CLARK, M.D. Fellow of the New York Academy of Medicine; Fellow of the American College of Surgeons; Member of American Urological Association; American Association Genito Urinary Surgeons; International Surgical Society; Sometime Major Medical Corps U. S. Army, etc. I13eto gotb THE MACMILLAN COMPANY 1921 All rights reserved rj /^' / a^ COPYEIGHT, 1921, By the MACMILLAN COMPANY Set up and electrotyped. Published, January, 1921 PREFACE If this small book serves to set in mo- tion a little more general thinking in this vast domain of human interest, it will have accomplished something. It is hoped that it will do more, by helping somewhat to lift the subject up from the back recesses of the mind and bring it forward into the daylight of open and purposeful discus- sion. With due recognition of the motives which in bygone days prompted teachers and parents to sustain a state of ignorance on sexual affairs, I have attempted to make clear the fallacy of this old, and what we now know to be, costly custom. We have long been in possession of sufficient knowledge of the child mind and its devel- opment to be able to supply it with in- formative matter, at such time and in such measure as to help rather than hinder the child's mental and moral growth. vi PREFACE If I have criticised society somewhat severely for its past attitude toward the sexual disease problem, I trust that it will be taken as constructive rather than de- structive criticism. If I have seemed unduly critical of the medical profession's part in this large human concern I should hke to state that I have the fullest confidence in that profes- sion's responsiveness to any real public endeavor which is sincerely aimed at the overthrow of this social menace. Society has so long disliked to have the comfort of its mind or mode of life dis- turbed that any contest with these dis- eases, which is scientifically rational, may, I fear, appear sorely radical. That which is simply direct may seem severely dog- matic. I believe, however, that if we would not strip off altogether the veil of sanctity with which we instinctively surround sex and its ennobling part played in the normal union of man and woman, it is high time this subject of the sexual diseases was met as it becomes brave men and women to meet a mortal enemy. PREFACE vii It is impossible to pass on without draw- ing due attention to the brilliant pioneer work of August Forel, Havelock Ellis and Prince A. Morrow in this particular field of social medicine. In the present after- war flare of attention to this subject it is to the vision of such men that much of our structural effort today owes its ground work. Though I remain acutely conscious of the many shortcomings of this small vol- ume, I still trust that it may prove to be in some degree suggestive. J. B. C. CONTENTS CHAPTER PAGE I Inteoduction 1 II Underlying Causes of Sexual Diseases 10 III What the War Has Revealed ... 22 IV The Role op Alcohol in the Sexual Infections and Fecundation ... 39 V The Prevention of Sexual Infections 44 VI What Every Boy and Girl Should Be Taught 61 VII The Importance of Universal Train- ing TO Sexual Health 77 VIII Systematic Care of the Sexual Infec- tions 98 IX Man's Obligation to Society . . . 125 THE CONTROL OF SEX INFECTIONS CHAPTEE I INTRODUCTION It may be stated here, that the subject matter of this book was not selected be- cause it is a pleasing topic to deal with; neither was it chosen because it is a re- proach to those who are mainly responsible for these disastrous diseases which we could get along so very well without; nor has it been picked out because of the world's per- fectly obvious neglect of this whole sub- ject ; but it was chosen because it is the firm belief of many well informed students that to-day, with the general interest and the sincere and active cooperation of the medi- cal profession with society at large, very much may be done toward the elimination of these truly terrible and insidious dis- 2 CONTROL OF SEX INFECTIONS eases. It is for this reason that the author offers this small contribution to the cause. In the rush of reconstruction we see the mask stripped from the motives of men; here sincerity shines, there selfishness and greed gain ground. Human nature has not changed, it has merely been exposed; yet it is only now, before the mortar of a new peace period has set, that the corner-stone of any new conduct can be laid. So much, then, of generalities from which each one must descend to his own sphere of labor, if the task ahead is not to be neg- lected. The sphere of the doctor's work like that of many others has been deeply changed by the war. With the doctor it has been an encouraging change. Up to the war he had been shrinking more and more into a technical and conventional rut along which he pursued his way. The war has shaken him out onto the surface of the earth again. He becomes once more a citi- zen. He has human interests as well as scientific. He thinks more of the work of the State and its obligations ; of sanitation and the general prevention of sickness and INTRODUCTION 3 injury. He even thinks of the physical and moral development of his fellow-man and the environment which will best bring these things about. In this new role then of cit- izen as well as scientist the world must needs look to the medical man for the suc- cess of its sanitation and its protection against preventable ills. It is here that we may well narrow our discussion to the sub- ject matter of this book, — that of the sexual diseases, which in themselves represent so large a part of the world's preventable ill- ness, which even represent no inconsider- able part of the world's preventable death- roll — both in utero and out of it. And yet (and this is what adds a peculiar interest to the matter in hand), here is a subject which polite society has seemingly not cared to meet face on. In fact, up to the period of the war this whole subject of sex- ual sickness has had in the English-speak- ing parts of the world a most singular ca- reer. As unmolested monarchs have these easily preventable infections marched into the innermost circles of society, without even arousing academic discussion as to 4 CONTROL OF SEX INFECTIONS their elimination — easy conquerors of an easy people. Can it be that society feels that the medical profession has done all there is to be done to forestall this festering and flourishing march? In that case the sub- ject is really an interesting one. Has so- ciety itself qualms as to the disgraceful side of these sicknesses? Certainly the pitfalls ahead of the young have been strangely well shielded from sight, and the whole sub- ject of sex secluded by secrecy and sham, much as if one generation had something very like personal reasons for keeping the next generation in the dark. So unmen- tionable indeed has this matter been in con- ventional circles that even the medical man with social aims of his own, — for many a good man steps down in the world when he thinks he is stepping up, — would carefully sink his professional activities with sex- ually diseased patients and throw up his hands in horror, much the same as anyone else, when the danger-line of this topic was neared. Thus has the future of our human family been dealt with. INTRODUCTION 5 Is it possible that our fashionable charity hospitals whose doors have been closed to these cases share any of the blame for the devastating tragedies of these diseases? All these are matters of no small impor- tance at this time of social reconstruction. And our ministers, and teachers of the young; — what has been their activity in this vital issue of sexual health and in- tegrity while they have been moulding the minds and characters of the future mothers and fathers of our race? Very suggestive are these hints as to why we suffer from such a prevalence of these pestilent dis- eases, but in the following chapters an effort will be made to centre the responsi- bility more exactly. Who would not be in sympathy with the general distaste of this whole vice-ladened subject of the sexual sicknesses! Cer- tainly only those with vice-ladened minds. But does that free society from its obliga- tions? Let us hope otherwise. One ap- preciates without effort how much pleas- anter it is even for the medical profession to exclude as much as possible the thought 6 CONTROL OF SEX INFECTIONS and suggestion of these ills from any branch of medicine. Even in urology it is pleasanter to follow in our practice the course of, for example, the surgical devel- opment in that branch, rather than to think and work^ or call attention to the fact that we work in terms of diplococci or wriggling spirochetes. But can we be so easily re- lieved of that which is disagreeable I Our recent war experience inclines us to think not. In that branch of medicine dealing mth the diseases of women — it is not only easier, but infinitely more profitable, to wait until, let us say, a gonococcus infec- tion has developed into a pelvic pus sac destroying motherhood and health for the woman, also providing a surgical opera- tion, than it is to turn our first and best energy into work preventive of these con- ditions. What a field indeed of medical prevention and endeavor the gynecologist — the specialist in disease of women — and the general surgeon too for that matter, has left open — and left behind him, while he mined gold dust from the gonococcus. INTRODUCTION 7 In France the peasants seem perfectly satisfied to have their dung-heaps piled up against the parlor door. They treat the matter with a delightful indifference. Can the medical profession go on being sat- isfied to have this social dung-heap de- posited against its own door? If it can, posterity will be very apt to deduct some of that profession's glory won in other fields. Frankly, if we are to meet this common enemy of our flesh — and spirit, and van- quish him, past tactics will have to go into the discard and a newer kind of warfare be employed, — a standing-up warfare with face forward, and an unmistakably plain, purposeful and sincere expression given to our will-to-win. Let us look for a moment into the merits of this term Venereal, with which from medieval times we have adorned these dis- eases, and see if perhaps our foes cannot be more successfully fought under their separate and more scientific designations. From Venus, the Eoman goddess of love, as is perfectly well-known, came the term Venereal to be applied to all sores and 8 CONTROL OF SEX INFECTIONS ^'issues" consequent upon sexual inter- course. For Gonorrhea, Syphilis and Chancroid were then all thought to be but different expressions of but one disease. That misconception has now been scientifi- cally swept away. If then we continue to use as a group designation of these three different and distinct diseases the term Venereal as a means of socially stigmatiz- ing those individuals who are infected mth these maladies, we should not leave out of account the numberless members of society who while exposing themselves continually to these infections, are not infected. Here is a discrimination wliich does not savor of justice; and if fair play is not to be a factor in a battle for moral betterment the laurels of war will not linger long on the heads of the victors. Again, with the broader social knowledge we now have of these diseases we know that they shower their curses on the virtuous wife and the unknowing babe with the same stern and relentless fury as upon the veriest rake. Furthermore, we know, that with simple precautions and with the use of equally INTRODUCTION 9 simple antiseptic measures the most vicious are fully protected from these in- fections, while the trusting bride or the faithful wife is thrust into a lifetime of purgatory, and blinded and otherwise blighted babies grow up to useless and burdensome lives. Once more, so much for the justice of this chastising term, Vene- real, which must follow the fouled wife or the innocent child oftentimes to the grave. The ancients thought the great evil lay in acquiring a sexual disease; we now know that it is a greater evil to transmit it. But the greatest evil of all must lie in the callous indifference which allows inno- cent women and children to become its vic- tims and then bathe their wounds in the wormwood of a word which stains their character. From what we like to call the practical standpoint, if we are to follow out a suc- cessful campaign against these diseases, infected persons and carriers of disease should not be driven under cover by the fear of an odious term, which too often is in no wav deserved. CHAPTER II UNDERLYING CAUSES OF SEXUAL DISEASES The mere possession of a rather com- plete scientific knowledge of the germ fac- tor in relation to these diseases does not, it would seem, lessen in the least their fre- quency or persistence. Text-book teach- ing of cause, symptoms, pathology and treatment, while giving perhaps the best instruction for the successful care of the individual case, furnishes no clue as to their general prevention. It becomes necessary then to view their genesis from a different angle if any foot-hold is to be gained in a struggle aimed at their overthrow. Thus it is that one is forced to study the social conditions which furnish soil for their growth, if the roots of the malady are ever to be reached. So closely related are our sexual declivities and diseases with our 10 CAUSES OF SEXUAL DISEASES 11 social declivities and disorders that it is impossible to study the course of the latter without uncovering causes of the former. Without further delay then, let us turn our attention to' these social conditions. What may be termed the ^^hush" system will make an excellent opening to the sub- ject matter of this chapter. It is that awe- some, ubiquitous, frowning ^^hush" pro- nounced like a whispered hiss, whenever the subject of the human reproductive func- tion in any of its phases is approached within the hearing of a ^* child'' under twenty-four or five years of age, unless of course the ** child'' is by that time a parent itself. This '^hush" was no doubt in- tended to keep the young ^^pure" and in- nocent and protected from ^* mistakes" which might lead to unfortunate con- sequences — shadowy, unrevealed conse- quences — ^perhaps to the contraction of some unmentionable state of ill-health, which might break out in unsightly sores or unredeemable disgrace to the family! This in a rough way may serve to illustrate the traditional treatment of the matter of 12 CONTROL OF SEX INFECTIONS sex by parents and teachers; a matter which each child of course, ferrets out for itself in league with its companions, from such literature as it can lay its hands on, augmented by '^stories" which give the finishing touch to its education on the '^physiology" of sex. This ''hush" or keep-in-the-dark system has been made a specialty by the English-speaking people. The cost of it in precious health and gen- eral moral uprightness has been very great. If space permitted, one might rehearse by way of illustration some tragic cases in both young men and young women, vic- tims of the "hush" method of rearing, who have come under personal observa- tion, and whose bitter experiences could be directly laid to the darkness in which they had been kept of nature's ways. The direct obligation wliich rests upon the parents of young children should no longer be left an uncertainty, and in the chapter dealing with what every boy and girl should be taught, the parents' part will not be omitted. From all sides should come nothing but CAUSES OF SEXUAL DISEASES 13 the truth of that which pertains to the sexual side of life; for alas! the past policy of ministers and teachers in their guardianship of the ^oung needs a start- ling change. The unsettled moral attitude which has influenced them in side-stepping this whole subject adds another cause to the prevalence of sex disease. By this time the perusing physician who is trying to find some redeeming point of interest in all this setting forth of an un- savory subject is wondering why he should be called upon to review the perfectly ob- vious and well-known fact of parents' and teachers' neglect in preparing their chil- dren for the sexual pitfalls in their path. Why indeed should the medical man be re- minded of parents' and teachers' short- comings even though it is the beginning of such a vast amount of sexual morbidity? We will let the answer be straight from the shoulder. Because the medical man and the medical man alone is the source of actual knowledge on this subject. What physician is there who has seen laid bare by the knife the pelvic contents 14 CONTROL OF SEX INFECTIONS of a woman diseased and destroyed by a gonococcus infection — seen her rendered sexless by the necessity of the case — seen her rendered physically and perhaps men- tally unstable by the same token, and who has not cried out within himself against the injustice of our unbalanced social life! What physician is there who has seen a number of babies blinded by the same or- ganism or the children tainted by syphilitic parents, whose very soul has not revolted at the sight, and yet, — and yet how little have we as doctors taken the fact to heart, that we alone are the only ones armed with that knowledge which can save so- ciety so much, so very much, of this wast- age, if we each did our part in the general dissemination of the facts in the case of these danger points ahead? What have our laws done to promote morality, or to prevent sexual infections? Take the case of professional prostitution which many look upon as the most fertile source of these infections, which it is not. The law aims to suppress and dislodge and thus finally to extinguish prostitution ; and CAUSES OF SEXUAL DISEASES 15 it does not do it. The records of such ac- tion in all countries and for all recorded time shows prostitution still in a flourish- ing condition. One niay almost say that it grows lusty on the processes of laws to abolish it. Some of the mightiest emper- ors who, it is said, tried to enforce such regulations could not themselves always obey their own moral ordinances. It is so much easier to make laws to regulate con- duct than to go to the bother of bringing up the young from birth with a sense of respect, let us even say reverence if you choose, for honesty and order and morality. What was it the ancient Jesuit priests used to say? ^^Give us a child until it is seven and you can have it after that.'^ They knew when the corner-stone of life's con- duct was laid. In its wisdom the law seizes many objects of art and paintings as obscene, while the obscenity is in the minds which think evil. Obscenity is sub- jective, not objective. We need not hope for reform to come from zeal alone, it must be flavored with intelligence. One reads that in the State of New York in 16 CONTROL OF SEX INFECTIONS 1907 a law was passed rendering any one guilty of adultery punishable by six months^ imprisonment, or a heavy fine, or both. It was expected that the law would act to prevent adultery. In less than three months after this Act became a law, law- yers came to the conclusion it was a dead letter. In the two years following its en- actment there were the usual large number of divorces, but only three people were sent to prison for a few days under this Act, and but four fined a small sum. The reader may judge for himself how much e:ffect this law had against immorality, or what its value was in checking commercial- ized vice. The ^^Eaines Law'' is another enactment with a history. With the idea of regulating the sale of liquor it achieved the most wholesale prostitution. As a learned writer once said, ^^all the repres- sion in the world can only touch the surface of life." We have mentioned the fact that the pro- fessional prostitute is not the greatest source of infection. This matter was gone into with great care both before and dur- CAUSES OF SEXUAL DISEASES 17 ing the war, and it was found, notably in Great Britain, that only a little more than one quarter of the infections in men were derived from the professional prosti- tute. This is not difficult of explanation, as those depending on prostitution for a living know much better how to keep them- selves free from infection. But from the casual participant, the working girl from the shop or factory or servant class or those who idle at home, the percentage of infections was almost three-quarters of the total on the tabulations made. This is doubly unfortunate as these girls not yet cut otf from self-respecting sources of sup- port still carry the hope of husbands and homes. Let us now move backward, as it were, and see if we can tell where the re- sponsibility rests for this vast group of in- fected and oftentimes sexually ruined in- dustrial workers who ignorantly spread the majority of the sexual havoc to all classes of society. First, it is just as well to look at some of the facts in the matter. In Great Britain, and on a much larger scale here in America, in all important in- 18 CONTEOL OF SEX INFECTIONS dus trial and commercial centers is seen the general employment of women, — young women between the ages of seventeen and thirty. For it is just these girls in their home-making and child-bearing period of life who seem to be most profitable to in- dustry and its ends. Many interesting questions and thoughts come to the surface of the mind when one takes in the idea of all these thousands upon thousands of young women in the flower of maternal possibility, losing the opportunity in so many instances of home-making and motherhood, and thus gaining freedom from temporizing sexual experiences, be- cause department stores and offices and factories can offer to their young and im- pressionable natures more bright lights and tinsel than the more enduring and further-sighted satisfactions of marriage can ofPer. Or are we figuring without our host? Is it that there are not enough hus- bands for these young women, and that they represent only the surplusage of the female sex? If this is so, then by all means let us encourage modern industry CAUSES OF SEXUAL DISEASES 19 and commerce to make all the money it can out of these girls and to employ these pos- sible mothers and help them by hard work and excitement to suppress and try to for- get their natural instincts. But we find that very large numbers of these girls have their transitory lovers and at least the threshold of their sex instinct is not denied expression, and we immediately are curi- ous to know why these are denied the full satisfaction of nature's most imperative demand, that of reproducing. This then must bring us a step closer to the truth of the answer that we are seeking: that the flaw is somewhere in the social system we are struggling under if it withholds the birthright privilege of mating and beget- ting its kind to this very large percentage of our people. Let us say then if it is the economic factor that cuts off from so many young people the opportunity to marry early and have homes and families it is economics gone wrong, as the home is the economic as well as the moral keystone of the social arrangement we like to call civil- ization. If it was possible to set up our 20 CONTROL OF SEX INFECTIONS form of civilization on the basis of the indi- vidual and independent home, as we did when we were money poor and mechani- cally unborn, it would be no impossible task to continue it now, barring, of course, some costly vanities we have fallen in the way of. We find then after this excursion into our social conditions that there is a vast deal of sexual infection kept moving about by reason of the fundamental error of an in- dustrial and commercial, or if you like social system, which rears such a barrier to early marriage and home life, forgetting that home life is not only the safest eco- nomics, but is the safest and best protec- tion against sexual diseases. As to the extent of this costly and degen- erating plague which destroys so much of life's happiness and purpose, some idea will be gained through the inventory re- vealed by the records of the war. To recapitulate, we find the following items to be outstanding social factors as underlying causes of our sexual diseases. (1) The system of silence on matters of sex; the parents' responsibility. CAUSES OF SEXUAL DISEASES 21 (2) Maintaining the policy of silence and the deception of the young as to the truth of sexual affairs, by teachers and ministers. (3) The physician's obligation to society, how this has been neglected. (4) Laws regulating sexual morality; and their utter futility. (5) Prostitution as a source of infection. (6) Alcohol. This is placed in a chapter by itself. (7) Industrialism which might well have been treated separately in a special chap- ter; and of which more will appear later. CHAPTER III WHAT THE WAR HAS REVEALED TMs chapter would be a considerable volume in itself were it to contain in any degree of detail the story of the costly consequences laid upon the world by the sexual diseases in the war from which we are just emerging. In periods of peace a vast deal of human energy can escape with- out much attention being attracted to it; but in a period of mortal conflict where every ounce of available man power is needed our senses are soon sharpened to detect the loss of fighting force which may cost us everything we are fighting for. So it was through expediency, we must con- fess, rather than through any commendable sense of morality, that we came upon a very dramatic exposure of society's inner structures. 22 WHAT THE WAR HAS REVEALED 23 Rather than go into statistical complexes to illustrate the dimensions of this social shame which our indifference in the past has so successfully fertilized, our purpose here will be satisfied if by contrasts rather than counts (although a few figures will be necessary) a general idea of the degrading plague we have so placidly entertained, can be given, and which the records of our recent war experiences have pointed out afresh. Inasmuch as the structure of society is merely a reflection of the individuals in it, and that the responsibility for its quality rests on each one personally and in propor- tion to that one's knowledge, it will soon be seen how personally interesting becomes the subject matter of this chapter. The first jolt to our national pride was registered with the initial draft of a million men in which Sexual Diseases took first place among the infectious conditions met with. Of all physical defects save flat foot and hernia, which were more numerous, the Sexual Diseases as represented by Gonor- rhea, Chancroid and Syphilis were the 24 CONTROL OF SEX INFECTIONS commonest conditions of disease or defect encountered. Through wide-spread educational cam- paigns the common evil of tuberculosis has become well recognized. This group of diseases, — the sexual infections, — was found to be even more numerous. The question which naturally arises in the mind is: Just how numerous were they? Quoting the Surgeon-General's Ee- port of 1919 to the Secretary of War, Vol. I, page 48, it reads: ''For venereal dis- eases during 1917-18, 259,612 cases were recorded for enlisted men in the United States. ' ' There it is, in black and white — a record which is probably as accurate as has ever been made of these diseases; ac- curate at least as a minimum basis, for there were at any rate that many recorded. Let the reader pause — and if he can, take in something of the meaning of these figures. High figures in these days we are very apt to brush away, as either too com- mon or too incomprehensible. Then let us think over the potential tragedy of just one case and let our imagination carry that WHAT THE WAR HAS REVEALED 25 single one through its possible social rami- fications of disease and disgust as it may be conveyed from man to woman, from woman to child, with its trail of complica- tions and catastrophes. And then try and conceive a quarter of a million of these loathsome diseases in just a given group — a sample group if you choose — in a given period in a small percentage of our popu- lation. It is monstrous, it is almost un- thinkable — and yet there it is — the fact. But some may think these figures do not represent the sexual disease conditions as they exist in civil life ; that it was the army life which provoked this high percentage. Let such minds be disabused, for on the contrary the rate of these infections went do^vn while the men were in the military service. For, for the first time in their lives in the almost universal majority of cases they were instructed and otherwise safeguarded from these infections. In the same army report quoted above facts are put forth to show as the record reads that ^'Approximately three-fourths of all cases that were recorded in the Army that were 26 CONTROL OF SEX INFECTIONS stationed in the United States during the two years were brought into the Army from civil life. The Medical Department of the army is very careful to leave no misapprehension in the mind on that score. And it has a right to take a just pride in its special work in the prevention of these dis- eases which it has been closely f ollomng up since 1909 when its campaign of preventive medicine as applied to sexual infections was begun. Unhappily the army does not have the same opportunity that is given in civil life to influence aright the minds of men from birth and to surround them with the early home environments which so largely determines the after life of every individual. As showing the result of the physical examinations conducted in the draft of the see-ond million men from civil life inducted into military service the following quota- tion from the report made by the Surgeon- General to the Senate Committee 1919 will be of interest : ' ^ This rate of 5.6 per cent, for all forms of venereal disease together, as shown in the second million men, must WHAT THE WAR HAS REVEALED 27 be taken as the most precise information we have concerning the proportion of men in the United States,, ages 18 to 30, who show symptoms of venereal disease at a given time." Five and six-tenths per cent., which means more than one in every eight- een, showed symptoms of infection. There is no whitewashing this minimum record of facts nor slipping from under that share of personal responsibility which rests on every citizen of an enlightened country who maintains a Social state of things which made that record possible. But let us examine a little more carefully into those figures which would stamp one out of eighteen of any given group of a million of our young men between 18 and 30 with a sexual disease. The report reads ^^who show symptoms.'^ Now those who know the nature of these diseases — Gonorrhea, Syphilis and Chancroid — know that the first two — Gonorrhea and Syphilis — which are the most important, the most far-reach- ing and which represent eighty to ninety per cent, of the groups — (Gonorrhea alone representing sixty to eighty per cent.) 2S COXTROL OF SEX IXFECTIOXS know that these diseases have not finished their course, nor their infectiousness, nor their liability to disabling complications simply because they do not show symptoms. It is also well known that gonorrhea and syphilis run long periods oftentimes when they show no symptoms and that only by the most searching microscopical and lab- oratory tests are we able to demonstrate their presence. In all this there is no hos- tile criticism of the methods of the draft board examiners, for even though they had had the experienced men and the necessary laboratory equipment at hand they had not the time available for the exacting tests by which to arrive at the true number of sexually infected men passing before them. So as a minimum estimate we can take the 5.6 per cent, as correct for those men who were openly and obviously suffering from a sexual disease ; but the numbers of gonor- rhea cases in which there was no urethral discharge, and where the urine was clear and the genitals, external and internal, (though I doubt if the latter were fre- quently examined), gave no obvious evi- WHAT THE WAR HAS REVEALED 29 dence of infection to the sight or touch, must have been very great. Personal evi- dence of this was given to me in very large groups of men pouring into one of the can- tonments, who arriving free from any ob- vious symptoms of gonorrhea, developed active recurrence of all these symptoms which might have been quiescent for many weeks or even months in civil life, but with the radical changes of living condi- tions and the burden of unaccustomed ex- ercises in drilling and the like were brought into evidence again. Of syphilis this was not so much the case, but even with syphilis there were considerable num- bers who, passing the draft board as free from this infection, bloomed out later on in camp. All this convinces the writer that the percentage of 5.6 is very much too low, and that the army is credited with a greater number of infections which came directly from our civil life plan of sanita- tion, and for which the army was in no way responsible. A very vivid impression of the costli- ness of these sexual infections is arrived 30 CONTROL OF SEX INFECTIOi^S at by the report of the Surgeon-General, which gives the time lost by the soldiers thus infected. It reads thus: *^The loss of time for venereal diseases for the year (1918) amounted to 3,937,710 days." Which disregarding a fraction figures out to mean 10,788 years. Here is a subject for the enterprising social economist to give us some ideas on, and if the matter of lost time is carried to the estimation of days lost in our civil life population omng to these diseases, where we can include the wives made life- long invalids, the blinded babies which must be largely supported for a lifetime, the cases of locomotor ataxia, paresis and a number of lesser disabling disorders which abound in private life and in our State supported hospitals and asylums, we shall see what an appalling period of time is un- necessarily lost, and what a financial bur- den the support of these victims of pre- ventable diseases we each of us share. It makes no difference whether these dis- eases are more numerous in the Southern States or less prevalent in the Northern WHAT THE WAR HAS REVEALED 31 States. That we have allowed them to become so alarmingly prevalent in both rural and urban communities both North and South is the thing to be kept firmly in mind. In this connection it is of no little interest to note that acording to the draft board findings the increment of sexual in- fections was somewhat greater from the country than from the cities. Early in our war experience it became evident to the commander of our forces abroad that to send men infected with gonorrhea and syphilis overseas would only add to our burdens and overtax France where accommodations and fuel were none too plentiful; so the orders came to send overseas no soldiers thus infected. The consequence was that in the camps and the ports of embarkation these men were continually increasing as they were being taken into the service until they were banked up, as it were, in camp hospitals and quarters and later on in development battalions, so called. At some points they reached in numbers to many thousands. They became embarrassingly numerous. 32 COXTROL OF SEX INFECTIONS and to the government increasingly costly. Methods of collective treatment nnder un- favorable circumstances, both as to equip- ment and expert care, were slowly set in operation. By the autumn of 1918 some order was coming out of the former con- fusion, and at some points there was promise of establishing a uniform and scientific form of treatment. Then came the armistice. Up went shouts of relief from soldiers and citizens, and for a period down went discipline and decorum every- where. And yet as far as the Sexual Dis- ease problem was concerned, there came at that moment an opportunity of golden rarity. For here on the one hand were these thousands upon thousands of sex- ually infected soldiers; still in the army; still under complete control. On the other hand here was the housing and the equip- ment and an increasing promise of real scientific treatment ready to undo their infectiousness and teach them the lesson of their danger to the community and to themselves, of uncured sexual infection. Here was the chance to keep them until WHAT THE WAR HAS REVEALED 33 they were free from infection and then send them back to their homes and fellow men, clean in body, strong in better re- solves, — apostles of a new view of health and decency, to take with them everywhere they went. I have no doubt more than one saw this moment of opportunity which would prevent these thousands of active volcanoes of infectiousness with their army restraint thrown otf, from rushing back to their civil communities to plant their seeds of disease. I have no doubt but that more than one wrote earnestly appealing to the authorities in Washington to further the obvious plan which would safeguard the civil communities from the danger which the premature release of these in- fected soldiers was sure to cause. Nor was the Medical Department of the Army at Washington unresponsive to appeal or un- prepared with a plan to keep these in- fected cases until they were free from in- fection. Orders were issued that they would be restrained and kept under treat- ment until, by the usual tests, it was con- sidered safe to have them return to their 34 CONTROL OF SEX INFECTIONS homes. The first orders to this effect were quite strict. Following orders were a little less severe. The other soldiers in the camps were rapidly being demobihzed. It is httle wonder that those being retained for treatment were restive and ill-satisfied mth their lot. Perhaps their relatives and friends in their home towns let their representatives know their anxiety to see the boys again. The ranks of infected ones dwindled. Perhaps those who were di- rectly caring for them had visions of home too, and became optimistic over the pro- gress toward cure which these multitudes of infected men showed. The army got smaller. In all departments it went on shrinking. Both the well and the sick seemed steadily to grow less. I have no doubt that some of these sexually diseased were rendered non-infectious before they were allowed to leave, perhaps a few of them were even cured, — but the great op- portunity was missed. Politically speak- ing, — we slipped by. There has already been enough written in this chapter to leave a pretty firm belief WHAT THE WAR HAS REVEALED 35 in the fact that the war has given a fairly good inventory of our social status as re- gards Sexual Diseases; but it has not yet given a full account of how much the war has increased this highly undesirable stock of disease. It is impossible to do this for the very good reason that the recording of our in- crement of these infections in France after the signing of the armistice, fell to the ground and the inspections so frequently held of returning officers and men was a form. The true number of those infected after the signing of the armistice can never be known. It is also impossible because we have no records to show the spread of these diseases in our civil communities by the men we have been referring to, and who were released on the public without the searching microscopical and other tests es- sential to a fair presumption of non-in- fectiousness. For all that the Medical Department of our army stands unique as among our civil institutions in the interest and the effort put forth by it to cope with sexual in- 36 CONTROL OF SEX INFECTIONS fections; and to the army and navy and U. S. Public Health Service the civil popu- lation of this country owes a debt of grati- tude for the program devised and the methods of instruction pursued; for they have put new and valuable knowledge into the minds of the army of men who were quite innocent of these vital things when the Government took them from civil life. In Great Britain also a rude awakening in this matter of Sex Disease has been dealt to its people. During the spring months of 1918 I was given the opportunity while in England to visit and study at first hand a fairly representative number of the hos- pitals devoted to the care of soldiers suffer- ing from sexual infections. Four years of face-to-face experience with these diseases, and the consequent distraction of sorely needed man-power, had awakened the British nation to a new sense of their sex disease situation; but they met that situa- tion with the same quiet determination and purpose which they have shown through- out their war experience. If civil life con- ditions as regard to these diseases were WHAT THE WAR HAS REVEALED 37 bad in the United States, they were no better with the English ; but they were com- pelled to call into play more drastic meas- ures with which to deal with them. So if we find them in the immediate future, as present signs indicate, coping with the sexual disease problem on a broader and more intelligent basis than we in the United States are pursuing, we must bear in mind that the war imposed more suffer- ing in this matter, as it did in every other department of life, on our English friends across the sea. To derive some idea of the number of effectives continuously out of action through these diseases, let us note the number of hospital beds which were provided for them ; early in 1918 there were about 20,000 beds and more special hos- pitals for their use being built. For, be it kno^vn, the English had the wisdom to build quite early in the war hospitals devoted exclusively to these cases, and to these hos- pitals properly equipped and well manned by expert medical officers the patients were directly sent before there was opportunity for the mismanagement of their infections 38 CONTROL OF SEX INFECTIONS by unskilled methods. Some of these hos- pitals had a capacity of as high as three thousand beds — larger by far than the largest hospital in New York City. Like ourselves here in the United States the British have taken up the matter of the future prevention of these infections, only with the British public it has become a burning topic. The English people seem at last to see in it the menace that it is to national health, happiness and prosper- ity, and by public discussion they are work- ing out their own problem. CHAPTER IV THE ROLE OF ALCOHOL IN THE SEXUAL INFECTIONS AND FECUNDATION There is little doubt that the majority of sexual infections in the male have been contracted under the influence of alcohol. Not deeply under the influence of alcohol, but enough so that temporarily the hold is lessened upon the steering gear of con- duct; so that the judgment is blurred and undue risks are taken ; and subsequent pre- cautions of disinfection are neglected. To the vast consequences of this fact is owed the larger number of male sex disease carriers. The next process in which alco- hol plays a ruinous role is to sufficiently blunt the conscience and banish reflection so that the infected male transfers his malady. By aid of alcohol men are often enabled 39 40 CONTROL OF SEX INFECTIONS to induce girls to take the first sexual step. This again may be complicated by the con- ditions just referred to where an infected man is the seducer. Thus it would seem that to alcohol a mul- titude of miseries are due. To those who are under treatment for a sexual infection, notably gonococcus in- fection or syphilis, the ingestion of alco- holic drinks works the greatest harm. The value of the treatment may be entirely vitiated, and more, the disease is very likely to be increased, or new complications developed. It is not yet entirely certain that the larger number of cases of loco- motor ataxia and paresis are not induced by the toxic influence of alcohol added to the processes of the spirochseta. So it is not difficult to deduce that in the realm of sexual infections alcohol is a baneful fac- tor. Can it be also that the toxic influence of alcohol changes the early resistance of the healthy tissues so that in the presence of the gonococcus or the spirochseta these organisms more readily gain a foothold? This is a question of no little importance. THE ROLE OF ALCOHOL 41 That alcohol has a depraving effect on the genetic sense is seen by its ability to turn se:^ual appetite to sexual phantasy, and thus on to sexual perversion in those with latent tendencies in this direction. But what is of the greatest consequence and perhaps of broader significance than anything yet attributed to alcohol is the part it plays in Fecundation. Although this subject at first glance may seem to be somewhat apart from the care and control of sexual infections it is in reality very intimately related to these questions; far with a sufficiently thick sprinkling of con- genitally subnormal children destined to grow up to be uncontrolled men and women, it is useless to hope to achieve the preven- tion of any social evil. For data regard- ing this subject I shall quote from Forel, the famous Swiss psychiatrist, in his book on the Sexual Question in which he says in regard to the relative evil of alcohol: '^But what is of much greater importance is the fact that acute and chronic alcoholic intoxication deteriorates the germinal pro- toplasm of the procreators." He then 42 CONTROL OF SEX INFECTIONS calls attention to the Swiss census of 1900, in which, there figured nine thousand idiots, and after careful examination of the bul- letins concerning them, it was shown that there were two acute annual maximum pe- riods for the conception of these idiots, calculated back nine months from birth; the periods of carnival and vintage, when the people drank most. ^*In the wine- growing districts the maximum conception of idiots at the time of vintage is enormous, while it is almost nil at other periods. Moreover, these two maximum periods come at the time of year when conception is at a minimum among the rest of the population; the maximum of normal con- ception occurring at the beginning of summer. ^ ' '^The offspring* tainted with alcoholic blastophthoria suffer from various bodily and physical anomalies, among which are dwarfism, rickets, a predisposition to tuberculosis and epilepsy, moral idiocy and idiocy in general, a disposition to crime and mental diseases, sexual perversions, and many other misfortunes." THE ROLE OF ALCOHOL 43 Here indeed is succulent food for the thoughtful mind; but it would be rash to make the statement tjiat prohibition of al- cohol is the solution of these difficulties we have just described. It is safe to say, however, that the coun- tries which build themselves up and pro- gress, and which prevent in no way the individual rights of the people, will in the presence of alcohol and many other dangers reach more rapidly a higher level of civili- zation than can nations which wall them- selves about with a great physical barrier as did China. Nations which prop them- selves up through a small governing class with barriers to free action, leaving the sinews of their character to shrivel and decay, finally lose the knack of self -protec- tion and real progress. CHAPTER V THE PREVENTION OF SEXUAL INFECTIONS A cooperative effort which ^ill embrace society from top to bottom, — that is what the Prevention of Sexual Infections im- plies. The employment of any single measure cannot be relied upon to accomplish the purpose. No groups of measures, no suc- cession of steps, no system, no matter how msely evolved or skillfully launched, can hope for any success unless the plan is approved of by a sympathetic public and carried forward with real sincerity. No good purpose will be gained by dis- guising the fact that the road ahead is a long one. Neither need we try to hide from ourselves the fact that the road mil have to be much cleared before we can 44 PREVENTION OF SEXUAL INFECTIONS 45 make any material progress. In other words, it ^\ill be quite useless to bring new measures into play and expect to see them operate successfully while the underlying causes of our present difficulty still flourish. ^^ Remove the cause and the patient will get well," is as true of society as it is of the single individual. Then the methods which are instituted for the prevention of these diseases will probably carry their own weight of usefulness; at the present time this is not the case. The necessary measures for the removal of the difficulties in our way are, for the most part, obvious ; it is the purpose of this book to try and point out the more important ones. In the short chapter dealing with the role of alcohol it was made quite plain that its unintelligent use constitutes perhaps the greatest danger to society, in not only un- dermining the germinal cells at conception but as a most fertile cause of transmitting and complicating sexual diseases. It is plain then that a quality of character will have to be cultivated which can resist the unwise use of alcohol. Especially is this 46 CONTROL OF SEX INFECTIONS SO in the United States at present, where in certain districts and among certain peo- ple the repressive measures of law tend to increase its consumption and decrease its quality. The lack of human consideration in our present industrial and commercial life may be laid alongside of alcohol ; and these twin evils may be looked upon as perhaps the two most vital factors in the corruption of society in which sexual infection and racial degeneration are running a close race. If we are going to clear the way and set in motion means aimed to do away with de- generation and sexual disease, a little further study of what has been termed *^the lack of human consideration" is nec- essary. It might also be spoken of in a broad sense as development without reflec- tion, for we have developed a system which has snared the captor as well as the captive. By the greedy efforts of many captains of industry ^^big business" has been accom- plished, but the human factor in combing the globe for wage-workers has been rue- fully neglected. So that we have in one PREVENTION OF SEXUAL INFECTIONS 47 half of a composite picture the over-rich with their sated families and satellites suf- fering from excesses and idleness, hunting fresh food for their Vanity while trying to wrest some satisfaction from the display of costly surroundings or some degree of public approval from their check-book charities. In the other half of the picture we see the great masses of industrial work- ers which have been rooted up from a wholesome rural environment and herded into physically unfitting, sex provoking, ex- citing and character destroying proximity, with practically all individuality extin- guished; held by the lure of an easier life and busy making the poorest goods for the greatest prices. These things, it will be found, will be real stumbling blocks in the way of such measures for the prevention of sexual in- fections as we may have to propose. On the other hand the chapter on what every boy and girl should be taught, and the chapter on universal training will deal with methods by which it is possible to accom- plish a very great deal against these two 48 CONTROL OF SEX INFECTIONS great social evils — alcohol and industrial- ism. Not to be neglected as a fruitful source of sexual infection is prostitution, but to fasten our whole attention on getting rid of prostitution, even if that were immedi- ately possible, would as a means of getting rid of these diseases carry us but a frac- tional part of the way. Though we may look upon prostitution as an unmitigated and degenerating evil in every form in which it appears, the act of doing away mth every individual prostitute in exist- ence would not cure prostitution; and the reason for this is simple, as the constant demand for them is almost entirely made by men; the number of women who are prostitutes of their own volition being comparatively small. The stupid steps which society takes in hounding these poor creatures whom society has itself created, while at the same time the male members of society who demand and support them are never reproached, mil furnish interest- ing matter for thoughtful study for those who can think on a higher level than that PREVENTION OF SEXUAL INFECTIONS 49 on which our police-regulation thinking is done. It is not the object of this book to go into the history of prostitution or to de- scribe the methods employed in the creation of this ancient profession in its various forms. All this has been amply written upon, from the favored mistress of the rich man down to the forlorn specimens of commercialized vice who are virtually bought and sold. What concerns us here is the care and control of sexual infections and to that end our sentiments regarding these unfortunate condition-made women should be radically reformed and our atti- tude toward them humanely altered if we hope to erase the sources of infection which they represent, and to circumvent the evil of prostitution itself; but this will require patience, wisdom, and a broad human un- derstanding. Morally speaking, the border line of prostitution is often obscure and difficult to detect, as women who prostitute them- selves in marriage for money, or childless luxury, will attest; these circumstances 50 CONTEOL OF SEX INFECTIONS have earned the title of ^^fashionable pros- titution." The distinction is further con- fused by the present-day large class of purely pleasure-seeking girls and women who shrink from household tasks which give the essential physical and educational preparation for matrimony and maternity ; and with powder and paint taking the place of the natural bloom of health and purpose these idle imitations of the female sex are everywhere in evidence, making their ap- peal to the baser side of men's nature. If the woman is to fulfill nature's require- ments of her, it is just as essential for her to have muscular work to do as it is for the man. Every nation which fails to ap- preciate this necessity must end in extinc- tion. The woman should develop bodily strength and health so that she may have strong, robust and intelligent children, and the genuine woman's ideal should point to nothing less than this. One of the greatest obstacles to our in- stituting measures of prevention of sexual diseases will be found in the false modesty which prevents open discussion of these PREVENTION OF SEXUAL INFECTIONS 51 diseases ; the groundless traditional terror that has kept this whole subject locked up in the dark. This it will be necessary to overcome and this we shall find is possible to overcome when a sincere interest is awakened and sincere efforts are being made in the practical work ahead in which all must take some part. Let us go on then to the discussion of practical meas- ures which can be employed. First and foremost is governmental sanction and ac- tivity. This is already assured, and in proportion to the ability and sincerity of the leaders and the backing of congres- sional appropriations will its progress be marked. It has begun its work with edu- cational posters and literature and with a number of public clinics for the treatment of these diseases. Many of the States have formulated campaigns and some are fitting in their efforts with those of the United States Public Health Service. All this has a promising trend, but without the live sympathy of the public, and more, without an insisting public demand for re- sults, these brave beginnings will be very 52 CONTROL OF SEX INFECTIONS apt to simmer down to meaningless forms. It will be the part especially of all physi- cians, social workers, religious and lay teachers and parents to keep abreast, through their departments of health, of this public service and see that it functions to the full need of their community. The appalling exposure of our social status through war-made records leaves nothing less than this in the way of personal re- sponsibility. What a city or a state department of health stands for in relation to the citizen should be better and more generally appre- ciated by every citizen. It is really not a prison to which burly police officers hurry otf their victims to be vaccinated or vapor- ized according to the dyspeptic disposition or decision of a doting judge; quite the contrary, it is the individuaPs best public friend. It is the citizens^ health club, so to speak, set up to ensure and protect the good health and therefore the greatest happiness of each and all of us ; and it is in this light we should come to think of it, to encourage it and to make use of it. PREVENTION OF SEXUAL INFECTIONS 53 The press is capable of a vast educa- tional assistance in publishing authorita- tive information regarding the progress of public health work in this field of vital public health interest. Too serious is this matter to be left festering in the dark any longer. Our children have a right to a dif- ferent policy than has marked our past per- formance in the matter of sexual sickness which has snatched the blessings of whole sight or clean bodies from so many of them. There are certain measures which every department of health should carry out, and be fortified in (where that has not already been done) by legal enactment. First, the reporting of all cases of Gonococcus In- fection, of Syphilis and of Chancroid to the Board of Health. This matter should not be shirked. These diseases should be reported under the name (not initials or number) of the patient. At the present stage of our social morality these patients should not be made to feel more guilty of disgrace than the guiltiness of the society which has through its neglect suffered such 54 COXTROL OF SEX INFECTIONS diseases to be rampant. That these dis- eases should be treated by any but author- ized physicians, should be illegal. All cases of Gronorrhea and Syphilis should be followed through their treatment by a record. The United States Army form of Syphilitic Register should be adopted, and a similar register had for Gonorrhea. The entire treatment should be recorded until a clean bill of health is obtained and freedom from infectiousness is determined by expert opinion. The completed Regis- ters should be filed mth the Department of Health. No certificate of marriage should be issued without a certainty ex- isting that there is no sexual infection present. The act of infecting another with a Sex- ual Infection through sexual intercourse should be a crime inevitably followed by heaw punishment, and with damages for the infected individual. This is the most important legal measure to be enacted in relation to these diseases. The crime of conveying Syphilis or Gonococcus Infection- — especially as a PREVENTION OF SEXUAL INFECTIONS 55 wedding gift — is comparable with murder, in that it is capable of destroying both health and happiness, without which life is worthless. The question of medical prophylaxis being pursued in civil life seems to have become a debatable subject. The argu- ment will follow its description. Medical prophylaxis as at present em- ployed by the army, consists of an equip- ment comprising the essentials for the fol- lowing treatment prescribed to be carried out as soon as possible after exposure to disease: — Washing the genital organs and surrounding parts with soap and water after the bladder has been emptied; swabbing the washed area with a 1 to 1000 or 1 to 2000 solution of bichloride of mer- cury; a urethral injection of a one or two per cent, solution of portargol; rub- bing into the genital and surrounding parts calomel ointment, thirty per cent. If this procedure of prophylaxis is promptly and properly carried out the lia- bility of infection should be practically nil. The antiseptic property of soap and water 56 CONTROL OF SEX INFECTIONS alone, if immediately and carefully nsed, and the urethra having been flushed by urination, mil in most cases be protective. The regular army medical ofi&cers, who have had by many years the fullest experi- ence in prophylaxis, showed by their great interest in this form of preventive treat- ment their confidence in its e:ffectiveness. There is no lack of evidence given in army literature as to the protective value of this affair if it is done soon enough after an exposure to disease. It is most effective if performed mthin one hour; but even if done after three or four hours it should protect the great majority of cases. Another form of prophylaxis has been employed, consisting of the essentials in a small packet which can be carried in the pocket and which gives the theoretical ad- vantage of prompt employment ; and which would be an actual advantage if used properly and promptly, which it rarely ever is. The essence of the whole pro- cedure is simply an evacuation of the bladder, a soap and water washing followed by antiseptic applications. PREVENTION OF SEXUAL INFECTIONS 57 The argument seems to be : Can we ad- vocate a plan of personal protection which tacitly sanctions prostitution? The an- swer to that argument is that, if rightly employed, it can be made a powerful dis- couragement to prostitution, besides being a public health measure of the widest im- portance. Only that form of prophylaxis which is given in a properly equipped and responsi- ble station under the auspices of the Health Department should be advocated. The personally administered pocket variety is not to be recommended. It is possible to make a prophylaxis sta- tion a social influence of peculiar force. From a mature, conscientious, high-class man in attendance the applicant can learn the dangers and disadvantages which at- tend prostitution. He can learn something of the general disaster following in the train of sexual infections, and the great burden of cost which it involves. Without preaching morality to him he will see the sense of the campaign against these dis- eases and perhaps become a disciple of the 58 CONTROL OF SEX INFECTIONS cause. Such stations should be kept as clean and orderly as an operating room should be kept, a lesson in cleanliness and order mil thus be conveyed and results will be enhanced. Eecords should be kept of the time of exposure to disease and time of treatment. If more than three hours has elapsed since exposure the patient should return for observation every other day for a week, and then once a week for a month so that he can obtain the benefit of the earliest possible treatment in the event of the development of disease. Probably one station of two or three treatment rooms would be sufficient in every twenty-five thousand of inhabitants. It is best to have them in hospitals when that is feasible. It mil be impossible to compel the use of these stations in civil life as it was in the army; but the army and navy having taught the advantages of prophylaxis to several million men, their economic advantage will soon come to be common knowledge. That methods of this sort should have to be thought of at all is rather more a stain on our citizenship PREVENTION OF SEXUAL INFECTIONS 59 and religion than a reflection on the means necessary to improve them. They will automatically go out of existence when so- ciety has washed its dirty linen, if it ever can. Our educational opportunities in the pre- vention of sexual infections will be spe- cifically dealt with in the succeeding two chapters. The U. S. Army demonstrated a value in social measures to diminish sexual temp- tation, or more strictly speaking the army gave its approval to religious and other or- ganizations to station themselves in and about army camps in order to entertain and enliven the soldiers by a higher minded form of amusement and companionship than the soldiers were likely to find for themselves. There can be no doubt that this plan saved from sexual infections many men who otherwise would have found companions whose acquaintance would have undoubtedly resulted in disease. In connection with loneliness and sexual disease very interesting studies were made of this in England VN^here infection was 60 CONTROL OF SEX INFECTIONS found to be so much more frequent among territorials on leave than among English Tommies on leave who had families and friends for companionship. So it is we see the underlying causes of the sexual infections — the factors which furnish the soil and nourishment for these insidious weeds of society, the roots of which delve so deep below the surface. And so it is that we must see that the re- sponsibility for these diseases rests on a society wliich, clothed in an ostensible righteousness, hurries by indifferent to the cost of health and happiness which lies so largely in its hands to prevent. Thus it becomes necessary to turn to the task of social readjustment and mend the evils that an industrial haste and alcohol and promiscuous sexuality have so firmly planted, before the sound sanitary meas- ures of prevention, which we have at hand, can justify their usefulness. CHAPTEE VI WHAT EVERY BOY AND GIRL SHOULD BE TAUGHT Here is the site upon which the store- house of human knowledge must find its foundation — the child mind — if a clear view of life for the individual is to be had. The most important mind impression pe- riod is up to eight or ten years of age. Or as a noted educator once said, "a child's education begins when it is born and ends when it goes to school.'' One might say the first impressions con- stitute the fibres from which the mental processes weave their fabric later on; so that in life each mind is clothed in coarse or cultured dress. Two periods of sexual instruction in youth are essential: the first before the child is conscious of sex ; the second as sex awakens. 61 62 COXTROL OF SEX INFECTIONS The first or early impressions should forestall the child's curiosity as to the birth of things, or be at about the same time that this curiosity asserts itself. What the childish mind is anxious to settle is where the kittens came from which seems of a sudden to occupy the attention of the house- hold cat. Of impregnation the little head is not at all concerned. But it is not necessary to await the cat's accouchement before the first lessons are installed. As soon as the child can take in the fact that from day to day the plant grows, the buds appear and then open into flowers, it should be led to this observation. The subject then of food upon which the plant grows can be made a lesson. Thus is the child mind gently opened to the ways of nature. But that a neiv plant may grow — this wonder is performed before its eyes — a seed is planted in the earth, and presently the little plant is bom. The lesson of impregnation, as the child's mind will later come to learn its ways in the life of fishes or birds or animals, is almost ac- complished. BOY AND GIRL SHOULD BE TAUGHT 63 From the seeds that gave forth a new plant the small mind can be directed to the egg which gives forth a new life. How the egg is born from the' hen is then made clear, and how the egg has grown up inside the hen mitil it is big enough to be bom or laid is explained. This teaching may well be aided by pic- tures or diagrams. When the child has grasped these simple facts of nature it holds a skeleton key as it were to practically all the rest. By this time the family cat may be almost ready to be delivered. The child's attention is di- rected to her increased size, and to the child's little mind is recalled the hen's ex- perience of keeping the egg before it is ready to be ^^born. " When the kittens make their appearance then there should be no undue surprise. And so the way opens for larger things. These details have not been set down to show just what is necessarily the best se- quence of natural events for purposes of child instruction. They have been thus set down to illustrate the child's mental capac- 64 CONTROL OF SEX INFECTIONS ity, and with what tact and gentleness the small mind must be initiated into the corner stone truths upon which the whole sexual structure is later on to be built. They have also thus been given to show how impersonally, how little hindered by the confusion of self-consciousness sex matters can be approached, and the impor- tant sexual truths can be calmly thought of and transmitted. This is the important thing just now for until one generation has thus been justly instructed we cannot hope that parents mil reflexly repeat to their progeny this vital knowledge. Thus then must this first period of sex teaching be carried on long before the sex- ual life of the child awakens into conscious- ness of self. From the more obvious events which at- tend the reproductive processes of animals, that is, the mother carrying her young and then putting them forth into the world, the child can be given some idea of how (let us keep in mind the household cat to illus- trate) these kittens grow and are nourished by the mother while she is carrying them BOY AND GIRL SHOULD BE TAUGHT 65 and until they are big enough to look out for themselves and be fed by their mother's milk after they are born. Then to go deepe'r into the subject of origin the child can be told how it is neces- sary for the production of these kittens to have a father as well as a mother, for it is the father which has the seeds of kittens which he must give to the mother before the kittens can start to grow up inside of her very much as the seed must be planted in the earth before the earth will produce the small plant as the child earlier ob- served. From this point of understanding it will not be difficult to bring the child to see that human beings are to all intents and pur- poses like animals in the way they have to carry their young inside of them until the baby is ready and big enough to be born. All of which can be made clear by pictures. This theme can be pursued into the realm of mother love and tender care of the child until it grows up ; and then, after the child has become either a man or woman its turn to parenthood will come with its opportun- 66 CONTROL OF SEX INFECTIONS ity to have fine healthy children to care for and love. Nothing bnt the truth concerning the processes of reproduction should be told to the child. Why should we ever be em- barrassed or hesitate to make clear to our own children the most beautiful and most w^onderful of all natural phenomena? The answer is simple; because we did not learn these things as wonderful or beauti- ful ourselves, or because we are afraid our children will discover what is in our minds instead. If all teachers and parents can feel and keep this one f ollo^\ing central truth clearly in mind, most of the difficulty of teaching how nature multiplies will be forever re- moved. Nature's sole concern is that we do multiply. The small matter of our fool- ish self-consciousness is of small moment to Nature in her larger task of keeping up the race. If we are bound on Nature's errand in life there will be no occasion for shame in the discussion of sexual matters \vith any- one. BOY AND GIRL SHOULD BE TAUGHT 67 It is not to be understood that this teach- ing of reproduction is to constitute the sole instruction of this period of childhood; but it can be taken to m^an that this early ob- servation and simple nature study com- prises the most important elements of be- ginning knowledge. Not only is this so from the standpoint of necessary informa- tion, but because in the young mind facts have been deduced from observation, which power has exercised and actually set into motion that most essential function of the brain — independent thought from personal observation. It has been contended in writings on so- cial hygiene that to teach one child the truth about these matters of reproduction and then allow that child the companion- ship of other children neglected in this re- spect and provided only with the fabrica- tions of indifferent parents who will not be bothered to satisfy that natural childish curiosity which is forever putting out in- quiry as its small mind gropes after infor- mation, will result in a negation of that teaching by the group opinions of its fel- 68 CONTROL OF SEX INFECTIONS lows falsely led. Let us not be concerned on this score for it is far more likely that the single seed of trnth fortified by the familiarity of personal observation will hold its own against the babel of unbacked belief and, what is more, may bring about conversion unawares. It is safe to say that in the case where nature's plan of reproduction is clearly put, before the child is conscious of its sex, that when that sex awakes nature's purpose will be plain. Added to this it is also safe to say that in the case of normal children growing up there is much less likelihood of sexual perversions finding a foothold. But how is this teaching to be brought about? It is true, that unless such instruc- tion and guidance can be put on a basis of universal teaching we shall be very far from accomplishing our object. Unless the present plan of subterfuge and sham can be replaced by truth and an actual effort toward enlightenment by longer strides than we are making in that direction now, the ground-work for preventive measures BOY AND GIRL SHOULD BE TAUGHT 69 aimed at the sexual infections will surely fail. There seems to be no division of opinion among the thoughtful and well educated people of the present day that it is the child's right to be thus instructed. Neither does there seem to be any doubt as to the parents' obligation in this matter. But how is it to be brought about? Both danger and difficulty seemingly lie ahead. Without some knowledge of anatomy and physiology, without some comprehension of sexual psychology, without a little inkling of botany, even these simple first period lessons on the essential beginnings of life will be far from perfect; and the second period of instruction at the oncoming of puberty will be valueless. With the hasty survey that so many of these problems get before they are dis- carded as out of the question, this problem could easily suffer the same eclipse. But we shall not allow it to escape us so easily as that. Of course the average parent is quite ignorant of the scientific facts in the case, and almost equally uninformed are 70 CONTROL OF SEX INFECTIONS our institutional teachers. Physicians likewise though they may know the scien- tific side are inexperienced in the way this matter should be set forth; they have neither the teacher's art of teaching nor the natural parent's deep concern of its child's welfare; but the sum of what the three (parent, teacher, and physician) pos- sess, however, is equal to the occasion. If we have the courage of our conviction, that it is the child's right to receive protective knowledge against disease, disgrace and de- generation, then let us see in what way we can best provide that necessary instruc- tion. What is needed for the first period of the child's sex character structure? First, a good example set by the parents in a cheerful and sanitary home. Here already much is being accom- plished toward this by the splendid work of '^community centers" and social work- ers. Then should come some such plan of child instruction as I have already out- lined. Parents must be instructed in this, and teachers provided by the local Health Departments could be easily trained to BOY AND GIRL SHOULD BE TAUGHT 71 teach the mothers the simple steps of this early instruction. Practically no scientific knowledge would be necessary beyond the explanations which 'would go with a few pictures and diagrams illustrating the plant study and anatomical cuts with which to make clear the reproductive processes of chickens, domestic animals and the human plan of carrying the baby before it is born. The act of copulation need in the child's mind be no more than the act of planting the seed, which is all that it is in the mind of Nature, so to speak. The sexual appetite or desire which imperiously demands the male of the species to carry out his part in the laws of reproduction by depositing the fertilizing sperm in the body of the female, does not concern this phase of the child's instruction, and right- fully belongs to the second period when the sexual feelings of the boy or girl are as- serting themselves, and when explanations of these natural phenomena will be un- derstood, and their high purposes appre- ciated. The normal child before it is seven or 72 CONTROL OF SEX INFECTIONS eight should be able to take in these simple but right guiding lessons. The tremendous value of satisfying the normal child's curiosity with a correct un- derstanding of these matters would be hard to measure. All the vain searching after some reasonable explanation of these phe- nomena would be at an end. All the foul smirching of the little soul would possess its antidote of truth. All the energy lost by the searching and smirching would be saved for something else. A profound re- spect for these wonderful processes of na- ture, a wholesome interest in all her ways and a beginning sense of its duty to human- ity would be the nebulous sentiments form- ing in the child's brain. Need we ask: Is it worth while? Now for a period of years specific sex instruction should be omitted. The knotty problems of the child have been solved. A confidence has been established between mother and child which will make the sub- ject easy of approach if the young boy or girl needs new enlightenment. Parents and teachers can turn to the task BOY AND GIRL SHOULD BE TAUGHT 73 of building up character and training the child's will, of developing its body and storing its mind. When the second period of sexual teach- ing comes it will require a very different treatment. It will be the obligation of the parents to keep on the lookout for the ap- proach of puberty. The boy now should be the special object of the father's obser- vations and the mother should watch for the girl's oncoming sexual life. At this time the father should tell the boy that seminal overflow or emissions are to be expected and that this is altogether a natural thing. The mother should ex- plain to the girl what menstruation is, and how it is likely to act. But further teach- ing than this, at this time of popular igno- rance of sex anatomy and physiology, should be carried on by the teacher quali- fied and trained for this work. It should be a part of all school training. Already it has been started here and there, but that is not enough. A well thought out and sys- tematically taught course in the anatomy and physiology of sex, with some instruc- 74 CONTROL OF SEX INFECTIONS tion on the sexual infections and other pathology, should be made available to every boy and girl reaching puberty. As mentioned before, it should be the parents ' care to know when the boy or girl is ready for this instruction and then enter them in the class. This should not be all: the school should also check up the parents' part so that no pupil is omitted. To start with, these teachers should be physicians until the teaching has reached a satisfactory standard, when it may pos- sibly be passed into the hands of conscien- tious lay teachers specially fitted for the work. The advent of the moving picture has made much possible in this field which would have been very difficult clearly to teach without this aid. There should be one course of instruction planned to meet the needs of the boys, and another for the girls. Besides making plain the mechanics so to speak of reproduction the sentiments of sexual life should be dealt with. Here it is that a great good may be accomplished BOY AND GIRL SHOULD BE TAUGHT 75 by setting the standards of sexual affinity and faithfulness on the high plane which should be their eternal place in the minds of men and women. 'The sexual life should be raised up from the low estate to which it has unhappily fallen along with so much else in our modern madness for material things. This instruction of boys and girls should do much to frustrate the counterfeit affections and vices which modernity has thrust upon us. The need of hereditary quality — a better breed — is painfully evident in the world today. There will be no better opportunity of impressing this need than at this mo- ment of sex teaching and it will do much in lifting to a higher level the world's habit of thinking in this department of life. And we must look more to the women of the race in the future to safeguard poster- ity. Women are destined to have a larger role in the destiny of man than they have ever had in the past; and it is time that education to that end should be available to them. If we are going to have a better progeny our present methods and aims of 76 CONTROL OF SEX INFECTIONS sexual selection will have to be mucli re- paired. * 'Social" advancement, money, ease, luxury — these are the moving factors in too many of our marital adventures of today. And adventures they too plainly often prove to be. That many are married but few are mated, is all too apparent. One has to make but a short excursion into this realm of sexual life to see the need of sexual instruction if we are to bar from the future the bitter fruits of our present social depravity, and our sexual diseases. CHAPTER VII THE IMPORTANCE OF UNIVERSAL TRAINING TO SEXUAL HEALTH Before pointing to any measures for the care and control of sexual infections which might be advantageously incorporated with a national system of training, it will be well to look for a moment at universal training as a social factor capable of in- fluencing the underlying causes of these diseases. This can best be done by a short review of this scheme of training, which in this or some similar form is bound in the future to be installed as an absolutely necessary health and educational, as well as national defense, measure for this country. It would not be pleasant to have to bring the mind to a belief that our national stupidity could be so complete as to take any other view of the matter. 77 78 CONTROL OF SEX INFECTIONS A moderate and yet what would seem to be an adequate plan for universal military training has been formulated, placed before Congress and received the commendation of the highest military authority as well as some of the best minds in the land. It has been pointed out that the sixteen cantonments built at a huge expense by the Government for the training of the re- cent national army, would be suitable for universal training and the accompanying vocational instruction in appropriate trades which are as important in time of peace as in war. It goes without saying that under a system of universal training and with a reserve built up thereby only a small regular army would be necessary. The evils and immoralities of a large standing army, or for that matter of any sized professional soldier force of un- married men, is all too well known. The maintenance of a large standing army means the maintenance of a large permanent professional prostitute class. The maintenance of a large professional IMPORTANCE OF UNIVERSAL TRAINING 79 naval establishment means exactly the same thing. On that score we should know exactly what we are doing if we vote down universal training. A small professional army only, backed by a trained ditizen Reserve, means the possibility of early marriage for the many; for universal training would put no bar to matrimony as does three or five years' en- listment periods in army or navy service. Again we should know exactly what we are doing when we put obstacles in the way of marriage. For a fighting force pick out married men every time — men with wives and homes and family honor to protect. Also men who are not liable, to the tune of one in twenty, to be unfitted by a sexual dis- ease. A very brief outline of the plan will be all that it is necessary to give here. There should be a short period of six months ' training for the male youth of the country on reaching the age of 18 or 19 years. 80 CONTROL OF SEX INFECTIONS This would be under direct Federal con- trol, in either the army or navy as pre- ferred. For the illiterate and non-English speak- ing there would be educational camps for a period of three months preceding the regTilar period. Have we not heard some- where that about 24.9 per cent., of the young men of the country would qualify for this preliminary educational advantage? It was proposed to naturalize aliens automatically who graduated from the course of training required. All young men on passing out of the training camps would for a period of ten years be on the reserve list and during the first ^ve years have several short periods (two or three weeks) of training so that they would not forget what they had learned; they would thus remain conscious of the responsibility, and so form that habit of responsibility of citizenship which with- out giving service to one's country is so prone to be lacking in periods of peace. During this reserve period of ten years each young man would have the benefit of IMPORTANCE OF UNIVERSAL TRAINING 81 an annual physical examination and medi- cal treatment if necessary. He would make also an annual report, thereby realiz- ing that he is on the books, as it were, of his country and a person of some impor- tance, instead of a creature with.no indi- viduality or identity. The psychological result of this is patent. It is not the business of this book to attempt to influence the intelligent reader towards taking a favorable view of this project of universal military training in order that he will advance its cause, for it is unthinkable at the present time that any lucid minded citizen is not doing this very thing for the perfectly obvious reasons which necessitate it, and which are quite aside from the advantages which it is the object of this chapter to point out. Now what are these advantages? First and foremost is the socializing fac- tor which would carry some real influence in the uprooting of the underlying causes of these diseases to which reference has been made. With the results of the modern Indus- 82 CONTROL OF SEX INFECTIONS trial and commercial stampede before onr eyes; where communities are packed with these wage-dependent workers, male and female ; where marriage is delayed or aban- doned and where respect for good manners or morals is unheard of and where sexual infections have pretty much their own way, the time does seem almost ripe to introduce into our national society some of the re- straining influences of discipline, a regard for order and decency, self-control and some educational assets. And it is these things which form the essence of the well conducted army training camp atmosphere, from which no normal young man can issue forth without bearing the marks of better- ment. But what is even more fundamental than these are the physical training and de- velopment, and the secrets of health which whet the appetite for clean, orderly and purposeful living. Some self-reliance might come to be established in the indi- vidual youth and prospective citizen — some courage and character which would help to pry him loose from the mass de- pendence and give him the confidence and IMPORTANCE OF UNIVERSAL TRAINING 83 wit to bargain for his own employment or start liim off on some individual form of livelihood which is even better. This era of industrialism which has been such a hindrance to human progress and such a fertile soil for sexual depravity while it has been so busy about its material accretions would in part be counteracted. Once this fatal habit of dependence on a job could be broken, this wage-slave form of discontented mind be cured, the out- stretched hands to charity withdrawn, and in its place the hot blood of self-respect and independent manhood set circulating, our eyes might now and then be greeted by the wholesome sight of a vigorous pioneer going forth to claim the treasures of the open air and fruitful soil. We might even see some of the abandoned farms once more peopled by earnest, hon- est folk surrounded by their healthy and happy children; and with such redeeming signs as these a real pride in our nation might again be reborn. Along with the physical upbuilding, edu- cational development and the Americaniz- 84 CONTROL OF SEX INFECTIONS ing influence which universal training could bring about, the power to set aright the minds of the young men regarding the evils of alcohol, opium and other drugs could be most effectively impressed. This must take no small part in this scheme for the national training of our youth if we are sincere in the desire to see humanity saved from the despoiling influence of these poisons. This deeply concerns any effort in the weeding out of sexual diseases as the chapter on the role of alcohol in relation to these maladies pointed out; and the re- sults of teaching the youth of the country as they come to their term of training, will be greater, I believe, than the results of prohibiting the manufacture and sale of alcohol. Universal training as a factor working toward the elimination of prostitution can be made both direct and indirect. It will be direct by the right training of the youth toward a clean and productive life, and by the encouragement of early marriage which a young man properly equipped vnth vocational and educational IMPORTANCE OF UNIVERSAL TRAINING 85 training will be better able to undertake than at present. It will be indirect by the results of this training which lead 'to early marriage and by the graphic lesson which it is possible to give of the frightful consequences of sexual diseases. Having seen then some of the possibil- ities of universal training in its influence on the social background of these sex in- fections, let us see what medical measures of practical value could be incorporated with such a system of general training. For this we need only look back to our recent war experience to gather informa- tion ; for what we did not learn from prac- tice we learned from our mistakes, and the linking of the two may be looked upon as good ground work for an excellent start. In each training camp there must of course be a general hospital and, as in our recent camps and cantonments, a special department for the care of sexual diseases. This branch, however, must be managed by an expert who has with him trained assist- ants. 86 CONTROL OF SEX INFECTIONS The fundamentals of this work must be standardized if uniform results are to be expected. A good many cases of these diseases may be looked for, unless a miracle has transformed our social state since we drafted three or four million young men in 1917 and '18. But, differing from that ex- perience, we should be ready for these infections with, specialists and adequate equipment. In this way those infected will not only get the best care possible, but will receive a lesson as to what is the proper treatment of these diseases. It mil be possible under universal training to keep the infected under treatment until cured or freed from their infectiousness ; for this can be carried on under government control even after their period of training is com- pleted. Those who are infected during their pe- riod of training can receive the prompt treatment which assures a cure in many cases in a surprisingly short period as com- pared with the older methods. Medical prophylaxis however should prevent the IMPORTANCE OF UNIVERSAL TRAINING 87 occurrence of many such cases. And as we make progress in this campaign along educational and social lines the occurrence of these disorders should grow less fre- quent. All young men as they pass through their course of universal training Avhether they come infected, or become infected, or remain free from infection, will receive full instruction (as did certain groups of our recent national army lucky enough to get where there was some system in this department of medicine) both as to the nature and danger of these maladies, as well as their correct care and avoidance. Let the reader pause for a moment to con- sider the significance of such a stupendous blow at this plague. Think of it ! Every youth in the land instructed concerning these diseases. No social effort, no health department service can for many years effect in the coming campaign on these dis- eases what it is possible to accomplish with universal military training, at one blow. I think we can conservatively say that no single measure at our disposal can accom- 88 CONTROL OF SEX INFECTIONS pKsh what the universal training system is capable of accomplishing in this depart- ment of hygiene. Let any citizen who for any reason does not favor universal training of the youth of the land bear this in mind: That the economic saving alone in human efficiency, if these diseases could be adequately con- trolled, would probably almost, if not en- tirely, pay the bill for this national system of defense and development, once it was properly established. So much then for universal training of the male youth of this country and its pos- sibilities in the upbuilding of our national manhood as well as the undoing of our sexual infections. But how about the girls who are grow- ing into womanhood? Are they to receive no training! Are they to receive suffrage and give no service ? This is a very perti- nent as well as a very important question of a most practical nature at this moment of social reconstruction. That all young women should receive some training in the fundamental duties pertaining to the IMPORTANCE OF UNIVERSAL TRAINING 89 woman's sphere is no new thought, for it was under discussion long before the great war came upon the world, in countries so- cially more advanced than our own. In the light however of the great social changes going on everywhere the idea of some suitable form of universal training for young women truly lifts before the lively mind new levels of hope. To think of a womanhood of healthy, strong, trained and capable individuals, is to think alto- gether in new terms of life ; and this is the moment for our minds to bend to thoughts which carry with them a promise of better things for our children. Soon, when the present flux of opinion becomes fixed into new and rigid conventions again, like the broken leg which is badly set, the time for a brilliant result will have passed and we shall have nothing better than the same old crutches to limp along on. It would seem worth while then to take a short mental excursion into this idea of universal train- ing for girls and see if in the interior of the thought there is really anything to hold our attention. 90 CONTROL OF SEX INFECTIONS Let US say that nine or ten montlis was the period of training which each girl as she reaches the age of 16 or 17 years would be required to take. She would start off with a three months' summer period of outdoor camp instruc- tion and physical development. The mind can easily imagine with what eagerness all normal young girls Avould be looking for- ward to this experience; but it would be difficult for the mind to measure off-hand, what the value of this would be. The greater part of the time in this pe- riod would be devoted to agreeable physi- cal exercises and games in the open; but they would be governed by order, punc- tuality, fair play and good temper, and the principles of discipline would be developed. All girls at this period would be learning how to care for and look out for themselves. They would make their o^m beds and keep their living quarters up to the sanitary standard of cleanliness and order. They would wear some regulation but simple uniform or costume. By their outdoor ex- ercises and healthful regime they would IMPORTANCE OF UNIVERSAL TRAINING 91 learn how nature applies her cosmetics to complexion, cheeks, eyes and lips — perhaps in time the face-paint and powder mer- chants would take ilp some more desirable trade and the drug-stores resume the sale of drugs. During this period a couple of hours a day could be devoted to useful in- struction, graphically and thus impres- sively given, of a fundamentally and uni- versally important character — things that every wom^an should know, such as: Health and how to maintain it ; illustrated by a little simple physiology and anatomy coupled ^th the principles of bodily hy- giene. Food; its values and how to pre- pare it, from the standpoint of economy and efficiency, as well as the palate. Household sanitation and order. Cloth- ing; the value of simple and wholesome dress. Sexual instruction. The impor- tance of physical (including muscular) strength and health; as opposed to the present average condition and conduct of women, which is making motherhood a sac- rilege. The processes of impregnation and reproduction and the dangers of the 92 CONTROL OF SEX INFECTIONS sexual infections to these and to the child. Instruction on social subjects, such as pub- lic welfare, order, safety and sanitation. Instruction in the principles of government and the responsibilities of suffrage. Fairly grounded on these subjects women can safely sit in Congress. During these first three months of bodily training, with a httle useful information — something like the above — added to it, a very exact estimate could be made of the physical and mental status of each girl. This might serve several good purposes, but the two most concerning us here would be, first, that a reliable statistical record would be gained for future guidance in such a system of universal training for girls, and second, a record which would be of im mediate value in estimating just what prac- tical service each girl would be best suited for in completing her course of training. This second period of training devoted to practical work should aim to ultimately become of economic value to the Govern- ment while serving to train the girl. The following might be taken as illustrative of IMPORTANCE OF UNIVERSAL TRAINING 93 such work as would fall within this cate- gory : First the arts of housekeeping such as cooking, sewing, gardening and the like, all of which would 'be taught on the basis of order, cleanliness and economy. The reader will not miss the broad field this opens up for cultivation. To these things a taste for beauty and harmony could ad- vantageously be cultivated. Outside those domestic duties which aim at some perfection of the home lie the ob- ligations of social welfare; and here it is that the training of the girl would embody not only some of the most useful of the actual lessons of life ; but it would be here also that her service might become of some economic value to the Government. In the field of social service, in district nursing, in the care of babies, in federal, state, and municipal hospitals, in diet kitchens and many other community institutions these young government uniformed assistants might for a certain period of their train- ing actually become factors of financial saving. With the cooperation of the Pub- lic Health Nurse a system might be worked 94 CONTROL OF SEX INFECTIONS out whereby a part of the girls' training might become a very useful one to society at large. This guidance would at least give them an insight into what may at pres- ent be considered one of the great social advancements of the day — that of Public Health Nursing. In each state the state's facilities for social welfare work could be surveyed in order to fit in the scheme of universal train- ing for girls mth that which has already been built up for social work within the state. It can readily be seen that this would of necessity do much to standardize this most important public health and edu- cational activity. During all this period of practical train- ing the girls would be under the supervision and direction of their commanding officers, so to speak. A certain amount of outdoor physical exercises would be required, or calisthenic exercise inside if climate or weather made that necessary; so that the habit of muscular activity would be estab- lished. They would be required to keep neat in their appearance and keep their IMPORTANCE OF UNIVERSAL TRAINING 95 bodies clean, their teeth carefully brushed, and all other habits pertaining to bodily hygiene firmly fixed. Short courses of in- struction to make clear all the work they were given to do would be given; and effi- ciency records would be kept of each indi- vidual, along with her personal, physical, and mental status and development. Unlike the training of the male youth, who would be placed on a reserve basis, the girls could be turned back to their homes at the end of the training period as having graduated from their obligatory service; but records of each would be had and in case of a national emergency the recruiting of trained and efficient assistants would be accomplished without difficulty. With this annual inventory of our matur- ing human values to go forward from we could perhaps build the foundation of some real national and individual worth. The conventionalized parents of some girls would at first see difficulties in the necessary hiatus in their school curricu- lum, but for the great majority it would be a great and ennobling finish to the school 96 CONTROL OF SEX INFECTIONS days of their early life and a sound begin- ning for their future individual and social usefulness. And by our usefulness must we largely measure the satisfaction of hu- man existence. But the reader may justly ask, what has this to do with the control of sexual infec- tions? As in the male youth of the land it would give a universal knowledge as to these conditions, and few girls, who actu- ally knew what these diseases mean to a woman, would lightly jeopardize all the health and happiness of life. As probably the large majority of prostitutes are what they are because they have no knowledge or experience of how to take care of them- selves and earn a reputable living, one of the main reasons for prostitution would perish. More women being physically and othermse fitted to be married and make good wives, mothers and actual helpmates, would undoubtedly be married. After a girl has had this socializing benefit, the knowledge and physical development as well as given an identity through service to her country, it is difiicult to think she IMPORTANCE OF UNIVERSAL TRAINING 97 would be so apt to fall or be led into prosti- tution. So by these and many other ways it is not hard to see how universal training for the young women would diminish pros- titution and the sexual infections, while in- suring sexual safety and the promise of a better race. CHAPTER VIII syste:\iatic care of the sexual infections Here is the logical beginning of this whole matter — the reduction of sex disease carriers by prompt and proper care. This is society ^s first task; to see that all hos- pitals are adequately prepared with a ra- tional system and a reliable staff to meet the situation which exists in all commun- ities. Society's first task; for it is even more largely due to society's near-sighted taboo than to the indifference of the med- ical profession as a whole that means of scientifically dealing with these diseases as a routine have been so entirely wanting. Though in the past many fashionable hos- pitals declined to take ^^disagreeable'' dis- eases, such as cancer or syphilis or gono- coccus infection and give them beds when bed treatment meant everything to the pa- SYSTEMATIC CARE 99 tient's prospects of relief and cure, the fu- ture will necessarily be colored by a differ- ent policy if we are going to war against these veritable enemies of the flesh. For it is war upon these diseases, it is to be remembered ; not war upon the individuals or their morality, or their religion, or their occupation, or their class of society; but war upon the germ factor of these maladies — clean, straight, unprejudiced, scientific warfare, which is the first business of the hospital and of the physician. Without the establishment of trustworthy departments for the care of sexual diseases, either as independent units as they are now plan- ning for in Great Britain, or as special services in existing hospitals, there will be very little progress made by broad-cast ad- vice to infected individuals to go and get good medical counsel and treatment. For until by institutional experience scientific- ally standardized methods are worked out and developed there will be no reliable standard for physicians at large to live up to; and those who know anything about medical matters know exactly what that 100 CONTROL OF SEX INFECTIONS means. There are already a large number of medical men who can be considered well equipped experts in the treatment of sex- ual diseases ; but how many of the sex-in- fected come under their care first hand? If the truth could be known the number would prove to be very small. Unfortu- nately it is just this first hand treatment upon which so much depends. We cannot hope for such a fortunate falling out of events as would see all the freshly infected people of the future coming promptly un- der the care of special and experienced workers in this department of medicine; but we can hope to see the early mishand- ling of these ill-favored individuals very largely remedied. This will best be brought about by setting a standard of care in our institutional treatment of these cases just as the surgical care for the individual with an attack of appendi- citis has been developed and become a safe routine procedure in the vast majority of such cases. When the scientific and suc- cessful care of these diseases comes to be more or less common knowledge among SYSTEMATIC CARE 101 people generally, the quack quick-cure of newspaper advertising fame, the dispens- ing drug-store clerk and the spurious specialist who have all been consigning these cases to the incurable class, will com- mence to vanish. When many general practitioners at large come to realize that the patients themselves have come to learn the difference between purposeful, scien- tific treatment and a bluff at knowing these diseases and how to handle them, they will be very apt' (for reasons best known to themselves) to either acquire the requisite knowledge and skill, or send these patients where they can receive proper care. More than one curious fact both in the medical world and out of it was made evi- dent by the war when it threw up upon the shore of peace its testimony. When the United States emerged from its belli- cose experience its medical assets for the general care and control of sexual infec- tions became painfully plain. While in practically all other branches of medicine there was some system, some cohesion which gave them a useful functioning basis 102 CONTROL OF SEX INFECTIONS with which to do creditable work, the de- partment which dealt with genito-nrinary ills went out of the army and navy service very much as it went into it — represented by a scattered few. But to that scattered few there still clings much valuable memory and experience from their work with the sexual disease situation which may serve society a very useful purpose. In giving the following sketch of a sys- tematic scheme for the care of sexual in- fections which we set up in one of our army camp hospitals during the latter part of the war it must not be supposed that this plan is to be considered the last word in the organization of a department for these diseases ; but rather is it to be looked upon in the light of a simple stepping- stone which may serve some small purpose in our progress toward a universally use- ful standard. It is also to be remembered in reviewing this army experiment that no such complete control of the situation is likely suddenly to be had in any civil com- munity under peace-time conditions. Before the work was begun the plans SYSTEMATIC CAEE 103 were fully laid out by drawings, models and description. It was then laid before the medical officers of the hospital and camp in order not only to get their criticism but to get their intelligent cooperation in what was such an important phase of army medical work; for unless a general under- standing of any new organization is had, the objective aimed for is not apt to be reached. While it was with the idea of putting the collective care of these infec- tions on an orderly basis, there were three specific purposes which were set down as its special goal. First, the importance of put- ting these diseases under treatment at the earliest possible period of their onset. Second, the employment of means which would materially shorten the period of in- fection. Third, to get a more definite as- surance as to the completeness of cure. All of which has been previously much neg- lected. The first purpose was made very plain to all medical officers who were apt to see these cases in the field. In cases of a doubtful genital sore (nearly all genital 1Q4 CONTROL OF SEX INFECTIONS sores are doubtful) the danger of any anti- septic application or treatment which ruins the dark field microscopic diagnosis of syphilis was emphasized, and directions to send immediately all such cases to the genito-urinary service in the hospital was made very clear. In cases of any urethral discharge or complaint of premonitory symptoms, all such (mthout temporizing treatment) were to be prom]3tly sent to the genito-urinary department. This matter of getting at these patients at the earliest possible moment of their dis- ease is here especially stressed, because upon this opportunity alone is built all that is most useful in any systematic plan of care. An individual who loses the chance of treatment during the first few days or the first week of his or her gonorrheal dis- charge, or the one who has a genital sore and is not treated immediately, loses the high opportunity of a short period of infec- tion, and loses the opportunity for the definite cure which only this early entrance upon treatment can assure. Let there be no misunderstanding about the importance SYSTEMATIC CARE 105 of getting the proper treatment, at this first moment, of a sexual disease; for it is at this point in the sex disease road that ruin has been spelled out for the vast num- ber by the individual's ignorance, or by the quack, or the drug clerk, or some other in- dividual who is not qualified to care for these cases. In the establishing of this army depart- ment three buildings approximating three hundred beds and ample room space for examinations, records and treatment were placed at the disposal of the chief of the service, and let me say, that in this instance all the equipment required was as promptly as possible provided. To draw a finely detailed picture of this department in full action would dispropor- tion this little book, and perhaps not leave the essentials quite as clearly emphasized in the reader's mind, as a view more or less in perspective with the important and newer features in the foreground. Order and cleanliness were the first favors to be bestowed on this department. The time-honored tradition of ^Hhe worst 106 CONTROL OF SEX IKFECTIONS is too good for those patients" was promptly erased from the minds of any workers on this service who showed linger- ing traces of this former plan of treatment. It was made very plain that these patients were to be treated precisely as any other sick patients and their problems of sick- ness approached in exactly the same scien- tific spirit and humane manner as any other human ills. The result of this was no small item in our net receipts of pro- gress and improvement, and it brought out a real interest in the pathological study of these diseases. Under this plan the doc- tors and nurses soon became as keen as if a lot of new diseases had suddenly been discovered. Before the professional business of the day was begun in each one of these hun- dred bed buildings, a short standing con- ference called the ^4ine up," was held. All the workers in that building, ward sur- geons, nurses, ward men, etc., came to- gether and lined up according to rank on each side of the large square entrance hall. This assembly served a number of pur- SYSTEMATIC CARE lOl poses: We started the day by a ^^good morning," we saw that all were present and in working order. Eeports from de- partment heads were heard. Each one had a chance to otfer a suggestion or voice a grievance. There was no secret diplom- acy; we all knew just what we were head- ing for. In this way we all did our work happily, and got results. These ^' line- ups'^ usually lasted but a few minutes; in fact they were time limited as we went on a time schedule. After the conference, in- spection of the building and all that it con- tained, was made. By going from one to the other of the three buildings these duties were gotten out of the way before nine o'clock when professional rounds were be- gun. In carrying the reader with me on these rounds special attention will be called to such innovations as were instituted to simplify and make more effective the care of these diseases. Starting with the building for the treat- ment of syphilis, chancroid and skin dis- eases: In the care of syphilis certain wards were assigned for the different 108 CONTROL OF SEX INFECTIONS stages and types of tMs infection. Early cases with open and obvious lesions were placed in one ward. It was possible thus not only to isolate these patients in their most infectious period, but to obtain group studies of the disease in this way. The recording was simplified, the individual cases were better kept in memory and the results of treatment were more clearly dem- onstrated. When these patients had pro- gressed to a stage of ordinary noninfec- tiousness, their mucous membrane lesions healed and their skin clear, they were graduated to another ward with more free- dom. Now it was this typical early class of cases which constituted a group with the best opportunity for complete cure. But just what constitutes the right treatment for a complete cure has never been exactly determined; with the result that even with a typical class of cases no exactness in dosage or drugs or regime has ever been made a general rule. The consequence of this has been in institutional or collective care of these patients by what we might call the ^temperamental method^' where SYSTEMATIC CAKE 109 each patient is treated from time to time, as it were, according to the particular fancy or inclination of this or that medical attendant, that some patients have doubt- less gotten very complete cures with a mini- mum waste of time and material; but the numbers who are missing this desirable eventuality must be appallingly great by the usual hit or miss 'temperamental method.'^ It was for this reason that we instituted for this class of patients the formula called Standard Syphilis No. 1, which was built up from methods of treatment in the British Army and from recommendations made by our own army Medical Depart- ment (see next page). With this formula will be seen the pro- cedure followed in all ordinary early cases. It has a number of advantages hitherto not included in any single formula for the care of syphilis. Into its category can come the bulk of the early cases. Once it has been decided on for the pa- tient, that patient, theoretically speahing, is there and then assured a cure — a very 110 CONTROL OF SEX INFECTIONS STANDARD SYPHILIS NO. 1 A routine course of treatment for ordinary fresh cases of sjrphilis in otherwise healthy men (to be interrupted in the event of dermatitis, jaundice, or other signs of intolerance supervening). Each patient to be carefully scrutinized for signs of stomatitis or general malaise, his weight to be taken, and his urine tested before each injection. In conjunction with the employment of this course of treatment, each medical ofl&cer shall be familiar with "Pro- posed Modification of Circular No. 14, W. D., Office of the Surgeon-General." Patients are to be treated at base hospital until open le- sions are healed, when they will be sent to development bat- talion or regimental surgeon for completion of treatment. The scheme of arsphenamin dosage is based on 150 pound men, or 1 decigram to about 30 pounds of body weight. Mercuric Salicylate, 33 Per Cent. Arsphenamin in Olive Oil. ( Intravenously ) ( Intramuscularly ) Gm. Grains. First day . 0.3 1.0 Sixth day 0.4 1.0 Eleventh day 0.4 1.0 Eighteenth day 0.6 1.0 Tiventy-fifth day 0.6 1.0 Thirty-second day 0.6 1.0 Thirty-ninth day 1.0 Forty-sixth day 1.5 Fifty-third day 1.5 One month rest, then take Wassermann : If positive, re- peat entire course ; if negative, repeat the mercury alone. At the end of the second course, rest two months ; then take Wassermann, and give third course in accordance with rule for second course. During second year, if Wassermann is positive repeat en- tire courses as above. If negative give two mercury courses with four months between. SYSTEMATIC CARE 111 momentous thing for not only the individ- ual but for society. Practically speaking, however, we do not at all know that it is the best treatment in the world. What the best treatment is going to prove to be will only be discovered by some such theoretical basis which we start from and stick to long enough and faithfully enough to get results upon which judgment can be passed. Per- haps long before then a protective vaccine will forestall that judgment. The effect on the patient of being launched with a reliable ticket which should carry him safely to the end of his course proved a very happy thing. The formula was posted so that all officers, nurses and patients could read, understand and become familiar with just what w^as to be expected. The interest which each pa- tient took was remarkable, and the readi- ness .mth which he cooperated only attests further the advantage of mutual under- standing in the furtherance of mutual un- dertaking. On the progress sheet of the record the formula was rubber stamped and checked 112 CONTROL OF SEX INFECTIONS off by the medical officer as lie gave the treatments. The simplicity of this record made it readable at a glance. With this formula the surgeon's obliga- tion to see his patient through is immensely lightened by having so many steps in a long and wearisome course of treatment decided at one stroke. The results of this treatment as far as we went were highly satisfactory and as the patients were discharged from the hos- pital their syphilitic register was stamped with the formula Standard Syphilis No. 1, with the hope that they would fall into the hands of those who would continue its course. Of the atypical cases of syphilis, the chronic cases and those complicated by vis- ceral diseases there is little to be said here, beyond the fact that they were carried along in the general orderly system under such individual treatment as seemed indi- cated. Neither did the cases of skin dis- eases fall under any formulated class treat- ment as did the early cases of syphilis, chancroid and gonococcus infection. SYSTEMATIC CARE 113 The chronic, complicated and crippled cases of gonorrhea like the advanced syph- ilitic received such accredited treatment as seemed best suited to the individual prob- lem, and all of this is adequately dealt with in text books on this subject. It is beyond the boundary of this book, which essays to deal with the topic of control of sexual infections, to go into the discussion of those cases which are the fruits of our past in- difference and neglect. They should have; all the humane and scientific attention which we can give them; and we should see to it that their likes are not repeated in the future. The early cases of chancroid were put into their class group and treated by means of constant cleanliness and exposure to sun- shine. This rapidly healed the majority of these cases. From the chancroid group we constanly reclaimed cases of syphilis; for of these cases which were closely fol- lowed up with *^dark field" examinations a surprisingly large number were found to be thus doubly infected. Of all the problems difficult to face in a 114 CONTROL OF SEX INFECTIONS satisfactory scheme of treatment for the sexual diseases, that of an effective treat- ment for gonococcus infection must be placed first. Here is a disease without a specific drug, vaccine or certain remedy. Keliable au- thorities estimate that only a little more than one out of ten cases in the male are cured without an invasion of the posterior urethra and the integrity of the genital glands being violated. The occurrence which spells months or years of infectious- ness, and all too often permanent destruc- tion of tissues. Sixty to eighty per cent, of all sexual in- fections are gonorrhea. It is said to be the most widespread and universal disease affecting the adult male population. It is further said that seventy-five per cent, or more are at some time infected. It provides the majority of all pelvic operations on women, many of which destroy their sex or render them permanent invalids. The best clinical observers of this dis- SYSTEMATIC CARE 115 ease place fifty per cent, of the involuntary childless marriages at its door. More than twenty- j&ve per cent, of all the blindness is due to it. It is probably the cause of more social destruction than any other disease, not excluding tuberculosis. By such tokens, then, can the gravity of this disease be estimated and the importance of its purposeful care be measured. And so it was that an adventure into a formulated procedure of treatment for this disease became of peculiar interest; for it was with all these things in mind that the building with a hundred beds for an experiment in the care of this disease was begun. We can set aside the treatment of the chronic and complicated cases with a few words. They were cared for with all the well known and well tried modes of treat- ment that had gained for themselves some clean-cut claim to merit, and by these means an effort was made to remove, as far as possible, from these scarred and strictured and generally outraged tissues. 116 CONTROL OF SEX INFECTIONS the infection present. Resentful as one often becomes at this vast army of recur- ring chronics, these uncured and compli- cated cases which stumble on from one stage to another, it is hardly fair at pres- ent to put these cases all down to the blunders of either medical misattention or blame the patients themselves while no suitable standard for the successful care of the early infection has yet become gen- eral. As in the department for syphilis the cases of gonorrhea were separated in dif- ferent wards according to their type or complication. For the examination and treatment of these cases in groups a large room was equipped. Down one side, but free in the room, ran a trough where fifteen patients could receive at one time either injections or irrigations, each one being under the direct observation of a medical officer as he passed along in front of the patients under treatment. In this manner it was possible to see that each learned the proper method of his treatment. Tables were there for those groups receiving SYSTEMATIC CARE 117 instrumental treatment. Those receiving massage of prostate and vesicles had their progress checked up by immediate micro- scopic examinations. The strictest surgi- cal cleanliness was observed in all treat- ments. One room was equipped solely for the two- or three-glass tests which were checked up and recorded every morning with the first urination — there being a hun- dred pairs of urine glasses on shelves marked with their equivalent bed numbers. Twice each week smears were taken from each patient's urethra before urination, were Gram stained, were studied and re- corded. The records were simplified to the last degree so that the patient's pro- gress could be read at a glance. Any reader who would be interested to see this service more fully described and illustrated by pictures is referred to the Journal of the American Medical Association of April 26, 1919. Letting this abridged sketch of the de- partment for the care of gonococcus infec- tion in its various stages serve as a back- ground, we can turn our attention to the lis CONTROL OF SEX INFECTIONS formulated or special treatment alluded to. Here it was that we were to embark on an adventure into the realm of the gono- coccus which was somewhat of a departure from the usual day to day prescribing method of treatment. The direct object of this experiment was to see what proportion of these patients it was possible to bring to a complete and early cure before the gonococcus had in- vaded to any extent the urethral glands or follicles or extended back of the mem- branous urethra which guards the openings of the prostate gland and seminal ducts. To this end the uniform treatment was adopted which went by the name of Stand- and Gronorrhea No. 1 (see next page). A brief study of this shows it to be a succession of safe and simple steps, marked off into periods or phases ; but only by thus standardizing some plan and carefully pur- suing it is it possible to tell by what means the disease can most successfully be treated and brought under control. That it is only applicable to the early cases should not need further emphasis. SYSTEMATIC CARE 119 STANDARD GONORRHEA NO. 1 A routine course of treatment for ordinary, early and un- complicated cases of gonorrhea in otherwise healthy men. Employed at base hospital and continued at development battalion or bj^ regimental surgeon (to be interrupted in event of complications or intolerance). DURING FIRST TWO WEEKS In bed from four to eight days, then "up" if inflammation has subsided. Bland diet. Tvi^o glass test each morning with first urination. Smear on Monday and Thursday morn- ings, before urination. Sandalwood oil, 5 minims three times a day, and increase 5 minims daily until 15 minims three times a day, after eating ; then decrease 5 minims daily. Irrigation twice daily (at 5 feet, patient standing) with po- tassium permanganate, 1:8,000, from 105° to 115° F. The irrigation not to be "through," i. e., into the bladder, until the patient can relax without the slightest discomfort. Hand injections to be used while infection remains anterior. DURING SECOND TWO WEEKS Bland diet continued. Patient should be up all day, and doing from two to four hours of light work. Two glass test and smear as before. Do not repeat Sandalwood oil course, if improvement is marked as it should be. Irrigation twice daily as before, with potassium permanganate solution, 1:6,000 at 6 feet, or hand injections if infection is still anterior. DURING THIRD TWO WEEKS Diet bland, but increased. Patient should be having from three to six hours daily of light work. Two glass test and smear as before. If any discharge or cloudiness of urine is present, potassium permanganate, 1:4,000 irriga- tion. When free from symptoms (no discharge and clear urine) for two weeks, without treatment, and doing from three to six hours' work daily, the patient in most cases may be con- sidered fit for duty and infection free. Note — In seeking a useful basis of treatment for the ordi- nary run of gonorrheal cases it can be easily understood that no lesson of value can be learned unless the plan laid down is followed accurately in every detail. 120 CONTROL OF SEX INFECTIONS It will be the obligation of a more enlight- ened future to see that the opportunity of this first moment of the disease is not missed. It was not used in cases which had existed upward of two weeks, or in recur- rent cases. The formula was strictly ad- hered to as it was originally drafted, ex- cept for the fact that no local treatment (injections) was begTin until two or three days in bed had abated the existing acute- ness of inflammation. The progress sheet of the record was ruled oif into columns describing daily the discharge, urine, presence of gonococci and other remarks. It could be read by a look. The result of this treatment turned out to be far more satisfactory than was our expectation, in so far as we were able to follow our cases discharged as cured; and this we were able to do, with some of them, for many months. The curative results of this treatment were based on the following tests: 1. Before being taken off treatment: (a) no discharge: (b) a clear urine: (c) gonococcus free for a period of ten days. SYSTEMATIC CARE 121 2. With no treatment; with no restric- tion of activity; with no signs of disease for two weeks. The average time of cure, which included the two weeks ^ period of observation, was from five to six weeks. So far as we could tell, none of these patients had a recurrence. The best results were in those cases where there had been no previous infection and where treatment was begun during the first week of the disease. Of these 90 per cent, were returned to duty cured. In all of these cases the infection was cured with- out extending into the posterior urethra. Unfortunately there were only a small number of these cases for this study. Only twenty in the first week of disease. Of those cases where the treatment was begun during the second week of the disease the per cent, of cures dropped to 80 per cent, in this average period of from five to six weeks ^ care. These unusual results of what is prac- tically a reversal of the established statis- tical estimate of cures before the infection 122 CONTROL OF SEX INFECTIONS had extended from the anterior to the pos- terior urethra, we felt was in part due to the excellent general condition of these soldier patients who were leading a vigor- ous outdoor existence. But the chief fac- tor of success is first of all the rest in hed. This can not be minimized, and it is im- possible to lay too much stress on the im- portance of this measure in every case seen within the first two weeks of the disease. Until we have some specific remedy for this infection it is the physician's duty to so- ciety as well as to the patient to see that this essential requirement is complied with in all early cases of this disease which he sees. Probably the next most important ele- ment in this standardized treatment is the conscientiousness and care with which it is carried out. This has a twofold advan- tage. It assures in capable hands the thing being well done, and it assures the full con- fidence of the patient. As for the local treatment of injections we have no certain remedy, as is well known, but the important SYSTEMATIC CARE 123 thing is to do no harm with such remedies as we have. Though the results of Standard Gonor- rhea No. 1 chanced to be brilhant the plan itself required no special intelligence. It was the painstaking sincerity of the young medical officers who carried this plan out which deserves credit for its success. To many medical men this treatment will undoubtedly seem impracticable, so long has it been the custom to treat this disease merely with tilings and not with thoughts — merely by the motion of the hand, but without any motion of the brain — that the matter of its care has fallen into a lazy reflex act performed without a thought of the tragic train of consequences which this kind of callous treatment brings about. What our medical friends really mean when they say it is impracticable is that it is too much trouble ; but none Avhose minds are capable of measuring the human cost incident to gonococcus infection can fail to know that a cure of this disease at any cost is cheap. So many doctors cry: 124 COXTROL OF SEX INFECTIONS *^But we cannot put these patients to bed! — They must keep on work! — Their fami- lies would know! — They will not submit!'^ Oh, great physician, where has your author- ity gone? Do you look to please your pa- tient or to cure him I Are you looking for his dollars or his deliverance? If you are truly working for your patient's interest you will spare no time or pains in show- ing him the truth and seeing to it that he goes to bed, and in all other matters fol- lows your advice. It is better that a doc- tor goes hungry treating three patients a day properly than that he roll around in a luxurious motor pleasing thirty. CHAPTER IX MAN^S OBLIGATION TO SOCIETY Not infrequently is the statement made by an individual that the world owes him or her a living. When put by anyone in the form of a question, the answer can be unequivocally in the affirmative ; for biolog- ically it is so, the world does indeed owe all its creatures a living, if they are born with the vitality to gather it amidst the hazards of the process. But when an in- dividual means that society owes him a liv- ing, that is a very different matter ; for so- ciety is an association, or if you choose a club, in which the eligible must pay their proportionate way in good manners, fair dealing, and taxation or dues to defray the necessary expenses incident to such an ad- vantageous membership. This then brings us by a very direct route 125 126 COXTEOL OF SEX IKFECTIONS to man's obligation to society; and to ad- venture into this field for a few moments may not be without advantage. If this is so, if the nation can be called a club or mutual association, and states and cities and so on, subdivisions of this mutual benefit idea, and really not an arena for riot, a field for fighting one another's endeavors, a place of political plotting for private gains, an opportunity to profit by oppressive means; then we gain at once a very good notion of just how well we are managing this national club of ours today. A well run club with an acceptable list of by-laws and composed of carefully chosen members who remain in good stand- ing so long as they are well mannered, play fair, pay their dues and contribute their share to the upkeeping of their insti- tution, goes far to justify its existence and set a standard for all other social organi- zations. It does more ; by being just and by sticking to its rules it forms a habit of good order and understanding which robs its members of dissatisfaction or distrust. Such a self-respecting association pro- MAN'S OBLIGATION TO SOCIETY 127 vides a very good example to keep in the mind of the citizen of a nation, state or smaller community; but unhappily a very different idea has come to take the place of this desirable conception of human so- ciety. So different an idea indeed of our social organization has become fixed in the minds of such a considerable number of its members that no thoughtful person dares to put these ideas down to mere illu- sions. We here in America may say these unfortunate results of our well intentioned beginnings are biological reactions and can- not be otherwise ; but it is too easy thus to argue out our present state of psychic ill- health, or evade the obligations which our former neglect or lack of judgment have entailed. Starting from, or rather start- ing with, our declared independence as a nation which was set up in the midst of the greatest plethora of natural resources came the birth of a mechanical era full of the greatest promise of material plenty. As time went on, in order to haul these riches out of the earth or from the field to factory or foundry and from thence to 128 CONTROL OF SEX INFECTIONS distribute them it required a great human herd of helpers. At this point in our eagerness for gam we became blind to the first requisite of a well ordered association for the mutual benefit of all, and lowered the bars to mem- bership by omitting to inquire into the qualifications of our new members, in fact we did not want them as members at all, but so eager for their wage work were we that we told them we did, and that they must make themselves at home and con- sider themselves as equals in our club. Thus was the first rotten beam laid in the foundation of our ^'free'' society. With all these multiplying multitudes of alien races wresting riches out of the ground and in the factory for us, a great opportunity of political ^^ progress" became possible — these people who were unfit as **club mem- bers'' all became good for at least one vote. Another beam in our national structure. Any active minded reader can continue this process of ^ * constructive policy" until he has our present ^^club" house fully completed, and looks with pride upon the MAN'S OBLIGATION TO SOCIETY 129 handicraft and art entering into its com- position. It is with a ^' close-up^' here and there at our society that man can best pro- portion out what his obligations in that di- rection are. It is in this social state that the roots of the sexual infections find such a suitable soil. In discussing the control of these evils it is necessary then for us to acquaint ourselves with the sources of their nourishment. If we are to gain control of these degen- erating sexual diseases m^an^s obligation to society must show itself in more than a passive role. In this period of social re- construction it will be necessary to build our social structures up from a firmer base. Certain fundamental laws of nature will needs also to be recognized. The idea that we can repress the sexual instinct for the purpose of more profitably pursuing our industrial and commercial aims, will need, along with a number of other ideas as to human instinct satisfactions, a profound remodelling. At this moment of opportunity for the masses the long suppressed instincts of this 130 COXTROL OF SEX INFECTIONS large segment of society are showing them- selves in a number of interesting ways, which bids fair to undo, and perhaps with violent manifestations, what we had accus- tomed ourselves to term as either progress or profit. The natural pride of self-support, of self- respect, of good workmanship and many other traits to be ascribed as normal, have received a serious set-back as shown by the present stocktaking of an over-industrial- ized era. At present society is seriously sick. The war may be looked upon as a complicating coincidence of the disease. The past century of gorging, — of mechani- cal feeding, has fouled the digestive tract of our poor social body while it has left unused or shamefully abused other vital functions of its instinctive life. All this points plainly enough to the need of a better general social health be- fore the ravaging results of its sexual ills can be successfully brought to bay. But society is the individual — the social state is the individual state — so that if we MAN'S OBLIGATION TO SOCIETY 131 are going to obtain real results in the es- sential riddance of these infections — each one must have some clear cut impression of his or her part in the matter. Thus, those for example, who having read through the chapters of this small book, fragmentary and incomplete as it is, must through its testimony have come to a larger sense of their personal part and their unavoidable obligation. One cannot view with quiet unconcern the war-made records of these diseases, and knowing what is inevitably in store for the children of the next generation, quietly fold the hands and look on unmoved. No normal parents who have come to a real knowledge of the costly system of si- lence on the subject of sex with their chil- dren can easily pursue the old customs of sham in the future. Clergymen and all other ministers and teachers of the young coming to realize the enormous amount of suffering due to their default of this subject will hardly be satisfied to sit on in silence. 132 CONTROL OF SEX INFECTIONS We are in court, on trial before the children, whose lives have been laid waste by these sexual infections. It is hard to imagine any excuse which will be acceptable for this neglect of man^s obligation to society. FEINTED IN THE UNITED STATES OP AMERICA ^s\>\''' . ■'^'"■'j-"-^. y? ■':^ •»■^V;■■«t^ "'?'t7.yrfj"!"'tv W?!-^ > ^|w«g|g|^^yww^j|< ^^^^m^isj^m COLUMBIA UNIVERSITY LIBRARIES This book is due on the date indicated below, or at the expiration of a definite period after the date of borrowing, as provided by the library rules or by special arrangement with the Librarian in charge. DATE BORROWED DATE DUE DATE BORROWED DATE DUE i rr r» P^ r ff^ ij ■ V 1 1 ' 1 ', C28(n49) 100M RC201 Clark Cb42 1921 ^he control o-p ■^ "^ '^^ infections. ."^ro 1